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OCFS-4436. Incident Report for Child Day Care

OCFS-4436. Incident Report for Child Day Care
OCFS

The OCFS-4436 Incident Report is an official New York State form issued by the Office of Children and Family Services (OCFS) to document any illness, injury, or serious incident involving a child while in day care. Licensed and registered child care providers use this form to maintain accurate records, notify parents promptly, and comply with state reporting requirements. It ensures transparency, supports child safety protocols, and serves as a legal record during investigations or inspections. You can download the OCFS-4436 form for free in PDF format from our website.

Purpose and Use Cases

This form is used in the following situations:

  • Recording details of a child’s injury or sudden illness during care
  • Providing official notification to parents or guardians
  • Documenting medical treatment administered on-site
  • Meeting mandatory reporting obligations to OCFS when required
  • Maintaining confidential, standardized incident records for audits

Form Structure and Key Fields

The OCFS-4436 includes clearly labeled sections on both front and reverse sides:

  • Child’s full name and date of birth (DOB)
  • Program name and license/registration number
  • Date, time, and location of the incident
  • Detailed description of injuries (e.g., bruises, cuts, swelling)
  • Medical services or first aid provided and by whom
  • Signatures and timestamps from caregivers, witnesses, and parents
  • Confirmation of notification to OCFS (if applicable)

How to Fill Out Correctly

Follow these best practices to ensure compliance and clarity:

  • Print all information clearly in ink—do not use cursive
  • Record exact times (with AM/PM) and specific injury descriptions
  • Never include names of other children due to confidentiality rules
  • Obtain dated and signed confirmation from parents after notification
  • Attach additional pages if more space is needed for details
  • In case of a child’s death, call OCFS immediately at 1-800-732-5207

Download the Form

Get the official OCFS-4436 Incident Report for Child Day Care form for free in PDF format from our website. Simply click the download link—no sign-up or payment required.