Form LIC 624. Unusual Incident/Injury Report

The LIC 624 form is used in California Social Services to report unusual incidents or injuries that occur in licensed care facilities. The main purpose of this form is to document and report any incidents or injuries that may have an impact on the health and safety of the residents in the facility.

The form consists of several parts, including information about the incident or injury, the individuals involved, and any witnesses. Important fields on the form include the date and time of the incident, a detailed description of what happened, and any actions taken to address the situation.

Parties involved in filling out the form include the staff members who witnessed or were involved in the incident, as well as the administrators of the care facility who are responsible for reporting the incident to the appropriate authorities.

When filling out the form, it is important to provide accurate and complete information about the incident or injury, as well as any actions taken to address the situation. Supporting documents such as medical reports or witness statements may need to be attached in order to provide a full picture of what occurred.

Examples of situations where the LIC 624 form may be required include instances of abuse, neglect, or unexpected deaths in licensed care facilities. By documenting these incidents, the form helps to ensure that appropriate steps are taken to prevent future occurrences and that those responsible are held accountable.

Strengths of the LIC 624 form include its ability to provide a clear and comprehensive record of incidents and injuries, which can be helpful in identifying patterns or trends. Weaknesses may include potential delays or difficulties in submitting the form, as well as the possibility of incomplete or inaccurate information being provided.

Alternative forms that may be used in similar situations include incident reports or injury reports used by other regulatory agencies or industries. Differences between these forms may include specific fields or requirements based on the particular industry or context.

After submission, the LIC 624 form may be stored electronically or in paper form, depending on the policies of the regulatory agency or facility. The form may be reviewed by regulators, administrators, or other authorized parties in order to ensure compliance with applicable laws and regulations.

Overall, the LIC 624 form plays an important role in ensuring the health and safety of residents in licensed care facilities by providing a mechanism for documenting and reporting incidents and injuries.