New Jersey Unusual Incident Report

For anything that isn't an injury, New Jersey centers file the Office of Licensing's Unusual Incident Report. This is the form that asks whether the incident indicates abuse or neglect, and it carries the State Central Registry Hotline notice in full.

You don't choose it. Report the incident the way you normally would, and when the type is anything other than Injury or Allergic reaction, this is the form that comes out.

When You Get This Form

Two things have to be true:

• Your center's address is in New Jersey. That comes from the state on your Center Profile.
• The Incident Type is Illness, Behavioral, Near-miss, or Other.

An Injury or Allergic reaction at a New Jersey center produces the Accident / Injury Report instead. Centers outside New Jersey get the standard Incident Report.

The Abuse or Neglect Question

This is the part of the form that isn't on any other report, and it's the reason the Office of Licensing publishes it separately.

While you're filling in the incident form, you'll be asked Does the nature of this incident indicate abuse or neglect? It's a required Yes or No, and nothing is pre-selected, so it's a decision you make rather than one you accept by default.

Answering Yes opens a Child abuse hotline report block for recording the call you made:

• Name / ID of hotline screener — who took your call
• Date of call and Time of call
• Comments — what you reported and anything they told you

What the Filed Report Looks Like

Export Report on the incident opens a print-ready copy in a new tab. See Printing or Saving a Copy for the full steps.

The example above is a report that has been approved but not yet signed by the parent, which is how a report looks when you file it on the day. Name of Parent is already filled in, because it names the child's guardians rather than whoever signs.

The form carries, in order:

• The child's name, the date and time of the incident, the staff member writing the report, and the staff member who notified the parent
• Name of Parent, listing the child's linked guardians, and Date Parent Notified, which fills in once the parent signs the report
• Other Individuals Involved — a four-column grid of Name, Relationship to Child, Age, and Other Important Information, filled in from the Witnesses list on the incident form. It always prints at least three rows, blank ones included, and grows to fit a longer list. The Office of Licensing's own note above the grid suggests describing children as Child #1, Child #2, which you can do by putting that in the Name column
• The incident description, under the Office of Licensing's own prompt asking for the who, what, when, where, why, and how
• The State Central Registry Hotline notice in full
• The abuse-or-neglect answer, and when it's Yes, the hotline screener, date of call, and comments
• Follow-Up Comments and/or Actions
• Signature blocks for staff, director, and parent
• OOL/10.28.2017 in the footer, naming the Office of Licensing form this follows

What the Notice Requires

The notice printed on the form is the Office of Licensing's own wording, and it asks two separate things of you.

Call the hotline immediately when there is reasonable cause to believe a child has been subjected to abuse or neglect by a staff member or any other adult.

Tell the parents the same day any unusual incident happens at the center. The notice gives examples: unusual sexual activity, violent or destructive behavior, withdrawal or passivity, and significant changes in a child's personality, behavior, or habits. It also requires the center to keep the incident on file along with evidence that parents were informed, which is what the parent notification section and the filed report together provide.

Frequently Asked Questions