Critical Incident Report for Providers Only

24-Hour Child Abuse and Neglect
HOTLINE
(330) 434-KIDS (5437)





Summit County
Children Services

264 S. Arlington St.
Akron, OH 44306
Phone: 330.379.9094
Fax: 330.379.1901
Hearing Impaired: ORS 7-1-1

Critical Incident Report (for Providers Only)

In accordance with OAC 5101:2-9, Summit County Children Services' (SCCS) Internal Policies, and the SCCS Placement Service Agreement (please refer to the Agreement for full information), relative to children placed by SCCS, a typed Critical Incident Report must be filed for any incident listed in the SCCS Critical Incident Report.

SCCS must be notified by a call to the hotline at (330) 434-5437 within four (4) hours of the incident AND a typed Critical Incident Report must be sent via fax to the Director of Social Services by the end of the next business day. Fax (330) 379-9601.

This report is created in Microsoft Office Word 2010. (If you are using an earlier version of Word, please continue to use the paper form or download the Compatability Service Pack from Microsoft's website.) Below are the instructions for completing this form:

1. Click on the link to open the form in Microsoft Word. Critical Incident Report.

2. To complete the form, type in the shaded areas by the questions. Answer all of the questions.

3. Print the form. (For Microsoft Office Word 2007 and 2010, click on the File tab. select Print.)

4. Fax the completed form to the Director of Social Services at (330) 379-9601.

All Critical Incident Reports must be typed.

Non-Emergent Incident Reporting Hotline (330) 379-1952 (for Foster Care, Adoption, Kinship and Providers)

For incidents that DO NOT require an immediate response, such as a child that is AWOL, child restraints that do not result in an injury, school suspension or expulsion, and an injury that does not require emergent medical attention, information can be left on this automated system. This line will be checked daily during business hours. Please provide your name, provider agency name, call back number, first and last name of the child, date of birth of the child, along with a brief description of the incident including the date and time it occurred. This information will be forwarded to the assigned worker and supervisor. For provider agencies, please forward typed incident reports via fax to the director of Social Services by the end of the next business day at (330) 379-9601.