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STATEMENT ACKNOWLEDGING REQUIREMENT TO REPORT …

STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICESSTATEMENT ACKNOWLEDGING REQUIREMENT TO REPORT CHILD ABUSENOTE: RETAIN IN EMPLOYEE/LICENSEE FILENAMEPOSITIONC alifornia law REQUIRES certain persons to REPORT known or suspected child abuse. As a licensee or anemployee at a licensed facility or a child care institution, YOU are one of those persons - a "mandatedreporter."PERSONS WHO ARE REQUIRED TO REPORT ABUSEM andated reportersinclude a licensee, an administrator, or an employee of a licensed community careor child day care facility. [Penal Code ("PC") (a)(10)] Mandated reporters also include anemployee of a child care institution, including, but not limited to, foster parents, group home personnel,and personnel of residential care facilities.

meaning the negligent treatment, lack of treatment, or the maltreatment of a child by a person responsible for the child's welfare under circumstances indicating harm or threatened harm to the child's health or welfare. [PC § 11165.2] Willful harming or injuring or endangering a child meaning a situation in which any person inflicts, or

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Transcription of STATEMENT ACKNOWLEDGING REQUIREMENT TO REPORT …

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STATEMENT ACKNOWLEDGING REQUIREMENT …

www.cdss.ca.gov

LIC 9108 (3/05) PAGE 2 OF 2 SIGNATURE DATE WHERE TO CALL IN AND SEND THE WRITTEN ABUSE REPORT Reports of suspected child abuse or neglect must be made to any police department or sheriff's

  Report, Requirements, Testament, Child, Abuse, Suspected, Statement acknowledging requirement, Acknowledging, Abuse report, Suspected child abuse

IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM …

www.cdss.ca.gov

in-home supportive services (ihss) program health care certification form note: the ihss worker may contact you for additional information or to

  Health, Form, Services, Care, Home, Certifications, In home supportive services, Supportive, Ihss, Health care certification form

IMPORTANT INFORMATION FOR PROSPECTIVE …

www.cdss.ca.gov

state of california - health and human services agency california department of social services important information for prospective providers about the

  Social, Services, Information, Department, Important, California, Provider, Important information for prospective, Prospective, California department of social services important information for prospective providers

Important Information for the In-Home …

www.cdss.ca.gov

TEMP 3001 (11/15) PAGE 1 of 7 STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES Important Information for the

  Social, Services, Information, Department, Important, California, Home, Important information for the in home, California department of social services important information for the

LICENSE APPLICATION AND INSTRUCTIONS FOR …

www.cdss.ca.gov

LICENSE APPLICATION AND INSTRUCTIONS FOR FAMILY CHILD CARE HOMES This contains instructions needed to file an application for a Family Child Care Home license, and to gain access to

  Applications, Instructions, License, License application and instructions for

REQUEST FOR LIVE SCAN SERVICE - COMMUNITY …

www.cdss.ca.gov

guidelines for community care licensing (ccld) applicants who use a live scan site (ccld ordoj site) for fingerprinting instructions for the lic 9163

  Live, Request, Scan, Request for live scan, Ccld

STATE OF CALIFORNIA - HEALTH AND HUMAN …

www.cdss.ca.gov

state of california - health and human services agency california department of social services community care licensing division lic 9214 (6/16) page 2 of 2

  Health, Social, Services, Department, Human, Agency, Care, California, California health and human, California health and human services agency california department of social services

STATE OF CALIFORNIA – HEALTH AND HUMAN …

www.cdss.ca.gov

STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES . APPLICATION FOR SOCIAL SERVICES . To the Applicant: All sections of this form must be completed.

  Health, Social, Services, Department, Human, California, California department of social services, California health and human services, California health and human

STATEMENT ACKNOWLEDGING REQUIREMENT …

www.cdss.ca.gov

soc 341a (3/15) statement acknowledging requirement to report suspected abuse of dependent adults and elders name position facility note: retain in employee/ volunteer file

  Report, Requirements, Testament, Abuse, Statement acknowledging requirement, Acknowledging, Statement acknowledging requirement to report

STATE OF CALIFORNIA – HEALTH AND HUMAN …

www.cdss.ca.gov

REPORT OF SUSPECTED DEPENDENT ADULT/ELDER FINANCIAL ABUSE FINANCIAL INSTITUTIONS ONLY GENERAL INSTRUCTIONS PURPOSE OF THE FORM This form is to be used by officers and employees of financial institutions (“mandated reporter(s)”) to report suspected

  Report, Abuse, Dependent, Adults, Suspected, Report of suspected dependent adult

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