Child Name

Select the child's name.

Date of Notification

Enter the date of notification of the incident.

Date of Death/Incident

Enter the date of death or date when the incident occurred. Mandatory.

Describe (in detail) cause or circumstance regarding the death/injury

Enter the cause or circumstances regarding this death/injury. Mandatory.

Describe (in detail) interview with family

Enter the details of the interview with the family. Mandatory.

If child was hospitalized, describe (in detail) DCS involvement during hospitalization

Enter the DCS involvement during hospitalization.

Describe disposition of body (Fatality)

Enter the disposition details of the body in case of fatality.

Name of Medical Examiner or Coroner

Enter the name of the medical examiner or coroner.

Was autopsy requested

Select Yes or No.

If so, describe (in detail) law enforcement or court involvement

Enter the law enforcement or court involvement.

Describe (in detail) action taken to ensure safety of other children (list names and ages of children) and or victim (Near Fatality)

Enter the details of action taken to ensure safety of other children. This description will appear with the name and age of other child victims who have harm description as "Child Near Fatality" under this investigation. Mandatory.

Has there been any media inquiry or is attention expected

Select Yes or No. Mandatory.