Law Enforcement Contact Report
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Continue below if needed.) CHILD REMOVED FROM PLACEMENT ■ STAFF DISCIPLINED ■ WHO INITIATED CONTACT WITH LAW ENFORCEMENT (Optional): ■ OTHER YOUTH ■ NEIGHBOR ■ OTHER(Describe) __________________________ ■ STAFF ■ UNKNOWN OTHER OUTCOMES/ADDITIONAL INFORMATION: (Describe any additional outcomes resulting from the incident.) _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ (attach additional sheets as needed) LIC 624-LE (4/16) PAGE 3 OF 4 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ABOUT THE LIC 624-LE THE LAW: In accordance with section 1538.7(a) of the Health and Safety Code, “A group home, transitional housing placement provider, comm
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