LDSS-7019. Illness Injury and Indicators of Abuse Log

Form LDSS-7019, Illness Injury and Indicators of Abuse Log, is a form used by the New York State Office of Children and Family Services (OCFS) to document any signs of physical, emotional, or sexual abuse, neglect, or maltreatment that a child may have experienced. This form is intended to be filled out by any person who has observed or come into contact with the child in question and may have witnessed signs of possible abuse or maltreatment.

This form consists of several sections, including the following: the child's identifying information, the date of incident, the type of incident, the person(s) involved, the location of the incident, the type of abuse/neglect/maltreatment, the description of the incident, the type of injury, the action taken following the incident, the date the report was made, and the signature of the reporter.

Important fields in this form include the type of incident, the type of abuse/neglect/maltreatment, the description of the incident, the type of injury, and the action taken following the incident. It is important to be as detailed and accurate as possible when filling out this form in order to provide the most accurate information about the incident. In addition, the signature of the reporter is also a critical part of the form, as it serves as verification of the accuracy of the information provided.

The LDSS-7019 form would be used in any situation where a person may have witnessed or suspected signs of abuse, neglect, or maltreatment of a child. The form provides a way for the reporter to document any observations or suspicions in an official capacity, which can then be used to further investigate the incident and ensure the safety of the child. The form also serves to protect the reporter from any potential liability in the event that the situation is investigated further.

When filling out the LDSS-7019 form, it is important to make sure that all of the information provided is accurate and up-to-date. Additionally, if any additional documents are needed to complete the form, such as medical records or other forms of identification, those documents should be included as well. The form should also be completed as soon as possible after the incident has been observed or reported, as the information provided may be used to further the investigation