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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION UNUSUAL INCIDENT/INJURY REPORT INSTRUCTIONS NOTIFY LICENSING AGENCY PLACEMENT AGENCY AND RESPONSIBLE PERSONS IF ANY BY NEXT WORKING DAY. SUBMIT WRITTEN REPORT WITHIN 7 DAYS OF OCCURRENCE. RETAIN COPY OF REPORT IN CLIENT S FILE. NAME OF FACILITY FACILITY FILE NUMBER ADDRESS CITY STATE ZIP TELEPHONE NUMBER CLIENTS/RESIDE...

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How to fill out lic 624?

The lic 624 form can be filled out by following these steps:

1. Begin by entering your personal information, such as your name, address, and contact details.
2. Next, provide the necessary details regarding the reason for filling out the form. This may include information about a project, event, or any other pertinent matter.
3. Ensure that you accurately fill out all the required sections of the form, such as dates, signatures, and any necessary attachments or supporting documents.
4. Double-check your entries to ensure they are correct and complete.
5. Once you have reviewed the form, sign and date it to validate your submission.
6. Finally, submit the lic 624 form as instructed, either by mail, in-person, or through the designated online platform.

Who needs lic 624?

The lic 624 form may be required by individuals or organizations involved in various activities, such as:

1. Contractors or construction companies seeking permits or licenses for specific projects.
2. Event organizers who need to obtain licenses for hosting concerts, fairs, or other public gatherings.
3. Film production companies seeking permits for filming on specific locations.
4. Health care providers or facilities applying for licenses or certifications.
5. Individuals or businesses involved in hazardous materials handling or transportation, requiring permits or licenses.
6. Any other situation where obtaining a license or permit is necessary or mandated by local or state regulations.

Remember to always consult the specific regulations and guidelines applicable to your situation to determine if filing the lic 624 form is necessary and to ensure compliance with the required procedures.

Video instructions and help with filling out and completing community care licensing forms

Instructions and Help about lic forms

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People Also Ask about community care licensing unusual incident report

What is LIC 624?

LIC 624 - Unusual Incident/Injury Report.

What is an unusual incident report?

UNUSUAL EVENT OR INCIDENT: Unusual incidents include resident abuse, unexplained absences, or anything that affects the physical or emotional health or safety of any resident and epidemic outbreaks, poisonings, catastrophes, facility fires or explosions.

What is an unusual incident injury report?

UNUSUAL EVENT OR INCIDENT: Unusual incidents include resident abuse, unexplained absences, or anything that affects the physical or emotional health or safety of any resident and epidemic outbreaks, poisonings, catastrophes, facility fires or explosions.

What is the purpose of completing an incident report?

The purpose of an incident report is to state the cause of the problem along with corrective actions that can be taken to minimise the risk of a future occurrence. The forms can also be used as safety documents, outlining potential safety hazards around the workplace.

What is the purpose of completing an unusual incident injury report?

The unusual occurrence report is a guide to walk through a thorough investigation for a root cause analysis. An unusual occurrence report is to be completed for all injuries/accidents or any situation/occurrence that could pose a safety risk to patients or staff.

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