Hospitals are required to screen new parents and caregivers prior to the infant's discharge home to determine if the infant has a safe sleep environment at his/her residence. Facilities without IPHIS access should report their screening data using this annual aggregate reporting form. The form should be submitted by the first Monday of February each year.
Please note: this form must be downloaded to a PC, completed and emailed as an attachment to email@example.com This form is unable to be sent through an internet browser. Attempting to do so may result in the loss of information entered.