IMPORTANT: This report must be received by HONH within 24-hours of the incident. Failure to meet this deadline will result in a rule violation.
----ONLY 1 INCIDENT AND 1 CLIENT PER FORM----
Must notify HONH within 1 hour of the caregiver gaining knowledge of any of the following circumstances involving a foster child:
**A serious injury or illness involving medical treatment of a foster child
**The death of a foster child
**Removal or attempts to remove a foster child from the home by any person or agency other than HONH
**Any involvement of a foster child with law enforcement
**Police or sheriff involvement
**Use of Restraint / Bear Hug.
Must notify HONH within 24 hours or the next business day when any fire requiring the services of a fire department occurs within the home.
Must notify HONH and the placing agency within 24 hours when the foster home becomes uninhabitable for any reason
Must notify HONH in writing of any person residing for more than two weeks in the foster home.
List all persons who provided professional medical treatment (if applicable):
List people involved in the critical incident (if applicable):
If you checked "YES" to the use of a physical restraint, please answer the following questions:
Who has been notified about this Critical Incident?