DC Unusual Incident Report Form – Fill Out and Use This PDF

Updated: Nov 7, 2026

The DC Unusual Incident Report form is a crucial document used by the Division of Early Childhood Education to ensure the safety and well-being of children in child care settings. This form is intended to capture any event that deviates from the norm and could potentially harm children, including incidents like accidents, abuse, or facility issues. For those responsible for children's care, knowing how to complete this form accurately and promptly is essential.

To ensure the safety and well-being of children in your care, fill out the DC Unusual Incident Report form by clicking the button below.

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How to Fill Out Unusual Incident Report (UIR) Form

Unusual Incident Report (UIR) Form at a glance

What it is: Unusual Incident Report (UIR) Form: report any unusual incident to the Office of the State Superintendent of Education (OSSE).

Where and when to file: Child development facilities should submit completed UIR forms to OSSE.UIR@dc.gov.

Child development facilities must complete this form to report any unusual incident.

A filled-in Unusual Incident Report (UIR) Form example: a director reports a child's scraped knee

Unusual Incident Report (UIR) Form example filled out, example: a director reports a child's scraped knee — A child care director fills out the Unusual Incident Report. A child scrapes a knee, an Injury; no abuse is suspected, so the Yes boxes stay empty. The picture shows page 1 only, and its names and figures are sample values. Accident and Unusual Occurrence stay empty because the story reports an Injury. Person Involved, What actions were taken and by whom, and Signature and date stay empty because page 1 is the only page shown.

How to fill out Unusual Incident Report (UIR) Form, box by box

Reported by

Under PART I - REPORTED BY, fill in 1. Person Reporting Incident, Facility Name, Title/Position, Address, Home Telephone Number (with area code), Director/Owner, Date Reported, Time Reported, Office Number and Cell Number.

Incident information

Under PART II - INCIDENT INFORMATION, fill in 2. Date of Incident, 3. Time of Incident and 4. Date of Report, and mark the 5. Type of Incident: Accident, Injury or Unusual Occurrence.

Suspected Abuse or Neglect

Under 6. Suspected Abuse or Neglect, mark Yes, Was Child Protective Services (CPS) contacted? with Yes or No, or mark No, move to the next section.

Incident Location Address

Enter the Incident Location Address in Box 7.

Person Involved

Under 8. Person Involved and 9. Person Involved, mark Adult or Child, enter the Child's Age, the Name (Last, First, Middle) and the Home Telephone Number (with area code).

Description and details of incident

Under PART III - DESCRIPTION AND DETAILS OF INCIDENT, 10. Who, What, Where, and How: if necessary, attach a separate sheet for additional information. Skip this section and attach facility form, if applicable.

What actions were taken and by whom

Under PART IV - WHAT ACTIONS WERE TAKEN AND BY WHOM, enter what actions were taken and by whom.

Signature and date

Sign on the Signature line and enter the Date.

Common questions about Unusual Incident Report (UIR) Form

Where do I file it?

Child development facilities should submit completed UIR forms to OSSE.UIR@dc.gov.

Sources

[1] Unusual Incident Report (UIR) Form (Rev. July 2026), Office of the State Superintendent of Education, District of Columbia (the Official source link on this page).

Dc Unusual Incident Report Form PDF Details

Child care program providers across Washington, DC must submit an Unusual Incident Report (UIR) whenever an event deviates from normal operations and affects enrolled children. This OSSE document captures detailed information about each incident, including the parties involved, a chronological description of what occurred, and corrective steps to prevent recurrence. Providers must notify the Compliance and Integrity Division (CID) via hotline or email within 24 hours of any unusual incident and submit completed documents within 72 hours for staff review. The process covers incidents ranging from accidents and injuries to abuse allegations and facility issues. By requiring an authorized signature, the UIR upholds accountability across DC child care facilities. Understanding incident reporting requirements helps program administrators protect children and maintain compliance with DC OSSE licensing standards.

Question	Answer
Form Name	DC Unusual Incident Report Form
Form Length	3 pages
Fillable?	Yes
Fillable fields	39
Avg. time to fill out	10 min
Other names	OSSE UIR form, OSSE unusual incident, DHS incident report, DC unusual incident report