Exhibit H Submitting an Incident Report vs. Calling the Hotline.docx

DOCX document 32 KB Posted

Attached to
Master Agreement AZ|CTR056497
Contract number
CTR056497
Issued by
Arizona

About this file

This document is an incident reporting matrix from the State of Arizona's Department of Child Safety, specifically from the Office of Procurement located in Phoenix. The document delineates a comprehensive chart outlining various types of incidents that require either an incident report submission or a direct hotline call, with each incident type receiving a specific reporting protocol.

The matrix covers 24 distinct incident categories ranging from serious events like individual deaths, suicide attempts, and physical/sexual abuse allegations to operational incidents such as medication errors, property damage, substance abuse, police involvement, and child runaways. The document provides a clear, structured approach to reporting critical incidents, indicating whether each type of event necessitates an incident report, a hotline call, or both, which serves as a crucial guide for managing and documenting potentially sensitive situations within child safety and care environments.

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Text version

SUBMITTING AN INCIDENT REPORT VS. CALLING THE HOTLINE

State of Arizona Department of Child Safety Office of Procurement 3003 N. Central Ave Phoenix, AZ 85012

Incident Report
Call to Hotline
1. Individual deaths
X
X
2. Suicide ideation
X
3. Suicide attempt
X
X
4. Self-harm
X
5. Physical abuse and allegations of physical abuse;
X
X
6. Sexual abuse and allegations of sexual abuse;
X
X
7. Sexual contact or physical aggression between children
X
8. Any incident involving injury or trauma (i.e. accidents) regardless of treatment location;
X
9. When medicine is administered in an emergency situation;
X
10. Errors in administering medications requiring emergency medical intervention;
X
X
11. Adverse medication reactions resulting in medical intervention;
X
12. When a child in care suffers an injury, illness, or psychiatric episode that is severe enough to require hospitalization
X
X
13. Accidents occurring in the treatment facility or off-site, while under the supervision of the treatment facility's staff, requiring emergency medical treatment, which are not limited to near drowning that require resuscitation.
X
X
14. Threats and/or altercation with parent, staff or child(ren);
X
15. Assault, Fighting or Physical Aggression
X
16. Damage or theft of property;
X
17. Substance Abuse
X
18. Police involvement;
X
19. Emergency Evacuations
X
X
20. Transportation/traffic related incidents
X
21. Disasters, such as major fire in the facility when children were present or which affect individual care areas;
X
X
22. Child is arrested
X
X
23. When a physical restraint is used; and
X
24. When a child(ren) is determined to be a runaway.
X
X

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