Child Care Center Complaint Form

Child Care Center Complaint Form

Each complaint is assessed and prioritized based on a situation that may result in substantial, minimal or no harm to one or more individuals. Based on this assessment, an investigation could begin in as little as 48 hours or when staff resources are available.
Individuals filling out this form may also fill out the complaint form with the State of Nevada. Click here for more information!
Name (you can choose to remain anonymous, however, we still need your contact information to proceed with the investigation.)

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child

Other
Would you like to remain anonymous?
Please provide the child care facility or individual's information.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please indicate the nature of your complaint. Select all that apply:

Other
Date of incident

MonthDayYear
Date
Ages of children involved (select as many as apply)
Please provide specific details of your complaint.
Have any other agencies been contacted? (police, CPS, etc.)
Have you taken any actions?
Has anyone at the facility tried to address the situation?
Has this happened before to the same individual or others?
Please provide any other important information:
By signing below, I hereby certify that the facts set forth in this complaint are true to the best of my knowledge, or reasonably believed by me to be true. This complaint is drafted freely and voluntarily.

Please contact us if you would like further information and/or results using one of these methods:

Email: ccdfcentraloffice@itcn.org

Phone Number: 775-355-0600
Signature

Clear
Should be Empty: