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Incident Report Form

For confidentiality purposes, all information on this report must be de-identified. Use Child ID numbers only; identify families in association with the Child ID and name as "mom", "dad", etc.; and use initials for staff members and other persons involved, along with their title, e.g. "teacher ML."

If it's an emergency, call 425-917-7705 or 253-778-7705 before completing this form.

More information: Incidents and Findings Notification Procedure

Center / Site





Incident












Reporting and Follow-Up
Others notified of the incident and the immediate action/follow up taken
Others notified of the incident and the immediate action/follow up taken
Others notified of the incident and the immediate action/follow up taken
Uploads

If you have any forms or documentation related to this incident, please upload them here