Provide the name of the child care centre or private-home day care agency.
Provide the date that the Serious Occurrence Notification Form is posted on site.
Date of Occurrence:
Provide the date that the serious occurrence happened.
Provide the type of serious occurrence, according to the definitions set out in the MCSS / MCYS 2009 Serious Occurrence Reporting Procedures. The operator uses one of the following terms:
- Death of a child
- Serious injury caused by service provider
- Serious injury – accidental
- Serious injury – self-inflicted/unexplained
- Alleged abuse/mistreatment
- Missing child
- Disaster on the premises
- Complaint about service standard
- Other – complaint made by or about a child, or any other serious occurrence
Provide a one sentence description of the occurrence. (Sample wording for illustration purposes only, not intended as a comprehensive list):
Serious injury caused by service provider:
- A child was injured when a staff tripped on the playground and knocked over the child.
Serious injury – accidental:
- A child was injured while running in the playground.
Serious injury – self-inflicted/unexplained:
- A child was limping after outdoor playground play – no injury was observed.
- A staff member was alleged to have abused a child while participating in the child care program.
- A child was left on the playground unsupervised at the end of outdoor play.
- A child left the centre and was found later at home.
- A child walked to a friend’s home after school. The parent and the centre did not know the child’s whereabouts for one hour.
Disaster on the premises:
- Smoke was observed coming from the furnace room.
- Complaint about service standard:
- A parent complained that not enough food is served at lunch.
Other – complaint made by or about a child, or any other serious occurrence:
- A parent complained that another child bullies their child.
Note: physical restraint is not permitted in child care reportable child care serious occurrence category.
Action Taken by Operator / Outcome: (add update if applicable)
Provide a description of the action taken by the operator. This section will include the operator’s longer term plans and additional outcomes to minimize recurrence of the occurrence, e.g. behaviour management training.
- The operator sought medical attention for the child’s injury.
- The child was transported to hospital by ambulance, treated and released that day.
- Behaviour management monitoring will be conducted each month.
If an update is made to add additional actions taken/outcomes, the operator will indicate the date of the update.
The operator or designate (e.g. the child care centre supervisor) signs the Serious Occurrence Notification Form.