Form LIC 624 LE. Law Enforcement Contact Report - California

Form LIC 624 LE is used in California by licensed facilities to report any law enforcement contact or incidents that occur on their premises. The main purpose of this form is to document interactions between the facility and law enforcement agencies for record-keeping and regulatory compliance.

The form consists of sections where details of the law enforcement contact or incident are recorded, including the date, time, location, nature of the incident, names of involved individuals, law enforcement agency information, and a narrative description of the event. The form may also include sections for witness statements, officer information, and any actions taken by the facility in response to the incident.

Important fields on this form include accurately documenting the relevant details of the law enforcement contact or incident, ensuring clear and concise descriptions, and providing all necessary information to facilitate follow-up or investigations. It is crucial for the licensed facility to promptly complete and submit this form as required by regulations to maintain compliance and transparency.

Application Example: In a residential care facility, an altercation occurs between two residents, requiring the intervention of local law enforcement. Form LIC 624 LE would be used to document the incident, including the details of the interaction with law enforcement, actions taken by the facility, and any additional information relevant to the incident.