CDA Miami – Minor Incident Form

At CDA our mission never changes, lead people in a growing relationship with Jesus Christ. As we strive to fulfill this mission there may be times where an unforeseen incident may occur. In an effort to lead and protect the people we are serving we ask that the form included be filled out when necessary. Below are a few guidelines and instructions that will help you determine when the form should be filled out.

When should you fill out this form?

A. A child becomes ill or receives an injury that requires First Aid or medical treatment while under your supervision.
o This includes a bump or blow to the head or other visible injury regardless of treatment

B. A child is transported by ambulance from the facility.

C. An unusual or unexpected incident occurs that jeopardizes the safety of a child, such as a child left unattended, there is a vehicle accident (with or without injuries), or a child is exposed to a threatening person or situation.

D. There is an allegation or reasonable suspicion of abuse of a child.

E. An unapproved person attempts to remove the child from the room/ facility.

F. Any form of argument, harassment, inappropriate language, or belligerence is displayed to or from the child.