LASC-JUV-041Local

Report Of Child's Injuries Pursuant To WIC 317, Subdivision (e

Los Angeles Superior Court · Juvenile

This form was updated 40 days ago — make sure you're using the latest version.

Last updated June 22, 2026

Used by mandatory reporters to document and report a child's injuries to the court as required by California Welfare and Institutions Code section 317(e) in juvenile dependency cases.

This form must be printed and filled by hand, or opened in Adobe Acrobat.
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