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Licensing-Critical & Other Incident Reporting Form

Instructions:
1) Fill out all sections of Incident Form
2) Return to top of page and press "File" and "Print" to print a copy of the Incident Report for your records.
3) Return to Incident Report and press "Submit" to send electronically to DCFS.

Separate names with a comma
Separate names with a comma
Include scope and severity of incident and likelihood of reoccurance
Include measures taken to ensure safety and protection
Separate names with a comma
Select all applicable

Print this form before hitting "Submit". Return to top right of page and press "Print" in order to print a copy of the Incident Report for your records.