Fill in a Valid Mo 886 3228 Form Open Document Now

Fill in a Valid Mo 886 3228 Form

The MO 886 3228 form serves as a crucial document for the Missouri Department of Social Services, specifically assisting in the Missouri Child Fatality Review Program's thorough investigation into the circumstances surrounding child fatalities. Designed to guide investigators through a comprehensive examination of the death scene, this detailed checklist is instrumental in determining the cause and manner of a child's death, especially in instances that are sudden, unexpected, or suspicious. For professionals involved in such sensitive investigations, completion of this form with as much detail as possible is vital, supporting pathologists and other authorities in their efforts to understand and prevent future tragedies.

Click the button below to fill out the form and contribute to safeguarding children across Missouri.

Open Document Now

Understanding the importance of comprehensive investigation in cases of child fatalities, the Missouri Department of Social Services has developed a specialized tool, the MO 886 3228 form, also known as the Death Scene Investigative Checklist for Child Fatalities. This form is a critical component of the Missouri Child Fatality Review Program aiming to ensure that every child death is thoroughly investigated to determine its cause and manner. Conducted by professionals immediately following the tragic event, ideally within 24 hours, this complex checklist guides investigators through meticulous examination of the circumstances surrounding the child's demise. It anticipates the need to recreate the scene for accuracy, involves collection of vital information ranging from the victim's identifiers and pre-natal history to the minutiae of the environment and conditions at the death scene. It is designed to discern not only the medical facts but also to consider possible environmental and caregatorial influences, including the inspection of household, interview of witnesses, and rigorous documentation of any anomalies. Through detailed questions and the option to attach additional documentation, this form serves as an indispensable bridge linking initial on-scene observations to the definitive medical examination, thereby playing a pivotal role in uncovering the truth behind the unthinkable loss of young lives.

Example - Mo 886 3228 Form

STAT

MISSOURI DEPARTMENT OF SOCIAL SERVICES MISSOURI CHILD FATALITY REVIEW PROGRAM

PO BOX 208

JEFFERSON CITY, MO 65102-0208 (573) 751-5980

DEATH SCENE INVESTIGATIVE CHECKLIST FOR CHILD FATALITIES

(800) 487-1626

INSTRUCTIONS

When a child dies suddenly and unexpectedly, or suspiciously, a thorough evaluation/investigation of the scene is necessary to accurately determine the cause and manner of death. The scene investigation should happen as soon as possible after the child’s death, optimally within 24 hours.

This checklist should be used as a guide to your investigation of the scene of a sudden and unexplained or suspicious death, especially to a child under the age of one. Completing all information appropriate to the fatality will help the pathologist determine how and why the child died. For assistance, call (800) 487- 1626.

The questions in the checklist will lead you through a thorough investigation. It is not expected that you will be able to answer all of the questions. You should attempt to interview witnesses, EMS and emergency room personnel, child care providers, law enforcement, and other persons from the scene.

In conducting the investigation, criminality or negligence should not be assumed, but the possibility should not be overlooked. An empathetic, non- confrontational approach is both appropriate and effective.

Complete as many sections as possible. If appropriate, attach this form to your investigation report. Submit a copy to the Medical Examiner’s Office prior to the autopsy.

Because the child will probably have already been transported to a hospital or other facility, it is important that, based on evidence and witness accounts, you try to recreate the scene to approximate actual events. This may include the use of dolls or silhouettes to reconstruct location and position of body. Attempt to acquire scene and reconstruction photographs as appropriate.

Contact your Prosecuting Attorney’s Office to ensure that all laws and regulations are followed in the search of the area, the interviewing of witnesses, and the collection of evidence. Only use procedures and forms approved by your agency and prosecutor. Sample forms are available from STAT.

VICTIM IDENTIFIERS AND PRE-NATAL HISTORY

1. CHILD’S NAME

 

 

2. SOCIAL SECURITY NUMBER

 

 

 

 

 

3. SCENE ADDRESS

 

 

 

 

 

 

 

 

 

4. DATE OF BIRTH

5. DATE OF DEATH

6. RACE OF CHILD

 

7. SEX

 

 

 

 

 

8. DECEDENT’S ADDRESS

9. MOTHER’S NAME

10. MOTHER’S ADDRESS

11. MOTHER’S TELEPHONE NUMBER

 

 

12. MOTHER’S DATE OF BIRTH

 

 

13. MOTHER’S SOCIAL SECURITY NUMBER

 

 

 

 

 

 

14. GESTATION IN WEEKS

15. BIRTH WEIGHT

 

16. KNOWN MATERNAL PRE-NATAL HEALTH PROBLEMS (DIABETES, HYPERTENSION, ETC.)?

 

 

 

 

NO

YES

UNKNOWN

 

 

 

 

 

 

 

 

IF YES, DESCRIBE

17. WAS MOTHER TAKING PRESCRIPTION MEDICATION FOR ABOVE MEDICAL CONDITION DURING PREGNANCY?

NO

YES

UNKNOWN If yes, what type of medication?

18. PRE-NATAL MATERNAL CIGARETTE, ALCOHOL OR DRUG USAGE?

IF YES,

 

 

 

 

 

 

NO

YES

UNKNOWN

Alcohol

Cigarettes

Cocaine

Heroin

Marijuana

Methamphetamine

Other

 

 

 

 

 

 

 

 

 

 

19. KNOWN COMPLICATIONS OF PREGNANCY OR DELIVERY?

NO

YES

UNKNOWN If yes, explain:

20.LOCATION OF BIRTH AND NAME OF FACILITY

21.ATTENDING MEDICAL PRACTITIONER

22.BIRTH DEFECTS OR OTHER ABNORMALITIES OF DECEDENT AT BIRTH, DESCRIBE:

MO 886-3228 (11-06)

23. ANY FAMILY HISTORY OF SIDS OR OTHER INFANT DEATH?

NO

YES

UNKNOWN

IF YES, DESCRIBE DETAILS INCLUDING DATE OF DEATH AND LOCATION OF OCCURRENCE:

EVENTS SURROUNDING DEATH

24. PLACE OF FATAL EVENT (E.G., IN CRIB, IN CAR)?

 

25. DEATH WITNESSED?

 

 

 

 

 

NO

YES

If yes, provide detail in narrative.

 

 

 

 

 

 

26. WHO FOUND CHILD?

 

 

TIME FOUND

 

 

 

 

 

 

27. STATUS OF CHILD WHEN FOUND

 

 

28. WHEN WAS CHILD LAST SEEN ALIVE (TIME, WHERE, BY WHOM)?

Dead

Unresponsive

In Distress

Unsure

 

 

 

 

 

 

 

 

 

 

29. DESCRIBE CONDITION OF CHILD WHEN LAST SEEN:

30. MEDICAL ASSISTANCE SUMMONED?

NO

YES

31. 911 CALL?

 

NO

YES If yes, obtain tapes.

32. RESUSCITATION ATTEMPTED?

 

BY WHOM?

 

 

HISTORY OF PREVIOUS RESUSCITATION?

NO

YES

 

 

 

 

NO

YES

UNKNOWN

 

 

 

 

 

 

 

 

 

33. CONVEYED TO A MEDICAL FACILITY?

 

WHERE?

 

 

NAME AND ADDRESS OF FACILITY

 

NO

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34. WHO PRONOUNCED CHILD DEAD?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONDITION OF CHILD

 

 

 

 

 

 

 

35. BODY TEMPERATURE (DEGREES)

 

TIME

 

METHOD

 

 

SWEATY?

 

 

 

 

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

36. LIVOR MORTIS

 

 

TIME

 

WHERE OBSERVED?

CONSISTENT WITH POSITION WHEN FOUND?

NO

YES

 

 

 

 

 

 

NO

YES (See Question 44)

 

 

 

 

 

 

 

 

 

37. RIGOR MORTIS

 

 

TIME

 

38. HEMORRHAGE OF EYES, LIPS OR EARS?

 

 

NO

YES

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

 

39. CHILD APPEARS CLEAN, WELL NOURISHED AND CARED FOR

 

 

 

 

 

NO

YES If no, explain in narrative.

 

 

 

 

 

 

 

 

 

 

 

 

 

40. CLOTHING CLEAN?

 

RIGHT SIZE?

 

CLOTHING REMOVED AFTER DEATH?

CLOTHING TYPE

 

NO

YES

 

NO

YES

NO

YES

 

 

 

 

 

 

 

 

 

 

 

41. DIAPERS USED? (COLLECT AS NECESSARY)

 

 

WET?

 

 

SOILED?

 

NO

YES

 

 

NO

YES

NO

YES

 

 

 

 

 

 

 

 

 

 

42. ARE THERE BIRTHMARKS OR INJURIES OF ANY TYPE, INCLUDING BRUISES, SCRAPES, CUTS, BURNS OR DIAPER RASH?

NO

YES If yes, describe colors, shapes, sizes and locations in narrative. Ensure that necessary photos are taken if possible.

POSITION OF CHILD

43. SKETCH POSITION OF CHILD AND IDENTIFY WHERE IN CRIB, BED, OR OTHER PLACE

IF BABY IS NOT PRESENT, ENSURE THAT PHOTOS ARE TAKEN OF POSITIONED DOLL OR SILHOUETTE.

INDICATE DIRECTION OF CHILD’S HEAD (CHECK ONE):

N

W

E

S

44. WAS CHILD MOVED FROM ORIGINAL POSITION?

NO

YES

WHY?

MO 886-3228 (11-06)

45. POSITION WHEN DISCOVERED (REFER BACK TO QUESTION 43):

 

 

 

 

 

 

 

 

 

BODY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On Stomach

On Back

Seated Upright

Left Side

Right Side

 

 

 

 

BODY PINNED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pinned Vertically

 

Pinned Horizontally

Other Wedging

Not Pinned

 

 

 

 

HEAD AND NECK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Face Directly Up

 

Face Directly Down

Face to Right

Face to Left

 

Neck Flexed to Chin

Neck Extended Back

USUAL SLEEPING POSITION

 

 

 

 

 

 

 

 

 

 

 

 

 

On Stomach

On Back

Seated Upright

Left Side

Right Side

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

46. WAS AIRWAY OBSTRUCTED WHEN DISCOVERED?

 

 

 

 

 

 

 

 

 

Airway Not Obstructed

 

Right Nostril Blocked

Object Covering Mouth

 

Objects Near Face

Both Nostrils Blocked

 

Left Nostril Blocked

Object Covering Nose

 

 

 

 

 

 

 

 

 

 

 

 

 

47. DESCRIBE ANY OBJECTS COVERING NOSE, MOUTH OR FACE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

48. IF CHILD WAS FOUND FACE DOWN, IS THERE A VISIBLE CUP, POCKET OR DEPRESSION IN THE BEDDING?

 

 

 

 

 

NO

YES

Depth:

 

 

Diameter:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

49. IS THERE A VISIBLE CREASE ON FACE, NECK OR HANDS FROM PILLOWS OR BEDDING?

 

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50. MATERIAL FOUND IN NOSE OR MOUTH:

 

 

 

 

 

 

 

 

 

 

 

None

 

 

Formula

 

 

 

Bloody Froth

 

Blood Tinged Secretion

 

Mucous

 

 

Vomit

 

 

 

Dried Secretion

 

Other

 

 

 

 

Food

 

 

Froth

 

 

 

Urine or Stool

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

51. SECRETION FOUND ON:

 

 

 

 

 

 

 

 

 

 

 

 

 

Blanket

 

 

Sheet

 

 

 

Clothing

 

Pillow

 

 

 

Other Item

 

 

 

 

 

 

 

 

 

 

 

 

 

52. WHAT TYPE OF SECRETION

 

 

 

 

 

 

 

 

 

 

 

 

None

 

 

Formula

 

 

 

Bloody Froth

 

Blood Tinged Secretion

 

Mucous

 

 

Vomit

 

 

 

Dried Secretion

 

Other Secretion

 

 

Food

 

 

Froth

 

 

 

Urine or Stool

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

53. FACE IN CONTACT WITH WET MATERIALS

 

 

 

 

DESCRIBE:

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

54. IF FOUND WHILE SLEEPING, WAS CHILD SLEEPING ALONE?

 

 

 

 

 

 

 

 

 

NO

YES

If no, who was child sleeping with?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55. DESCRIBE BED AND/OR OTHER SLEEPING SURFACE.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

56. LIST ALL MATERIALS AND OBJECTS NEAR CHILD WHEN FOUND, INCLUDING BED, SHEETS, PILLOWS, COVERS, TOYS, HOUSEHOLD OBJECTS, ETC.

 

 

 

 

 

 

 

 

 

 

 

57. COULD ANY OF THESE MATERIALS AND OBJECTS HAVE INFLUENCED THE DEATH?

 

 

 

 

 

 

NO

Yes

If yes, describe in narrative.

 

 

 

 

 

 

 

 

 

 

 

 

 

58. IS THERE ANY POSSIBILITY OF OVERLYING? FOR EXAMPLE, TOO LITTLE ROOM FOR TOO MANY PEOPLE, RECENT ALCOHOL OR OTHER DRUG CONSUMPTION BY PERSON SLEEPING WITH CHILD.

NO

YES

If yes, explain in narrative.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

59. IS THERE AN APNEA MONITOR IN THE HOME?

 

 

 

 

WAS CHILD ON MONITOR AT TIME OF DEATH?

 

 

NO

YES

Download information from monitor.

 

NO

YES

 

Collect monitor as evidence.

 

 

 

 

 

 

 

 

 

 

 

SOCIAL AND ENVIRONMENTAL CONDITIONS

 

 

 

 

 

 

 

 

 

60. WHO DOES CHILD LIVE WITH?

 

 

 

 

 

61. WHO HAD RESPONSIBILITY FOR CHILD AT TIME OF DEATH? IN NARRATIVE, DESCRIBE

 

 

 

 

 

 

 

 

ACTIVITIES OF CAREGIVERS DURING DAYS LEADING UP TO THE DEATH.

 

 

 

 

 

 

 

62. HAVE FAMILY MEMBERS OR CARETAKERS BEEN REPORTED FOR PAST ABUSE OR NEGLECT?

 

 

 

FOR DOMESTIC VIOLENCE?

NO

YES

Contact Hotline to obtain information. (800-392-3738)

 

 

NO

YES

 

 

 

 

 

 

 

 

 

 

 

 

63. LIST CHILD CARE PROVIDERS - LICENSED

 

 

 

 

UNLICENSED

 

 

 

 

 

 

 

 

 

 

 

 

64. DO SIBLINGS EVER WATCH CHILD UNATTENDED?

 

 

 

 

65. ARE THERE ANY CULTURAL PRACTICES THAT MAY HAVE INFLUENCED THE DEATH?

NO

YES

If yes, age:

 

 

 

 

 

NO

YES

 

If yes, explain fully in the narrative.

 

 

 

 

 

 

 

 

 

 

 

 

 

66. DESCRIPTION OF DWELLING:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

67. CLEANLINESS OF DWELLING

 

 

 

 

 

 

 

 

 

 

 

 

BELOW AVERAGE

ABOVE AVERAGE

 

AVERAGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

68. NUMBER OF CHILDREN LIVING AT ADDRESS

 

NUMBER OF ADULTS

 

 

 

OVERCROWDED?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MO 886-3228 (11-06)

69. ARE THERE ANY ENVIRONMENTAL HAZARDS?

 

 

 

 

 

 

 

 

NO

YES

If yes, check all that apply.

 

 

 

 

 

 

 

 

Tobacco Smoke

High Room Temp

Recent Remodeling

Tobacco

 

Animals

 

Drugs or Alcohol

Low Room Temp

Toxic Gases

Lead

 

Other

 

Medicines

 

Unusual Dampness

Toxic Products

Electrical

 

 

 

 

 

 

 

 

 

 

 

 

70. ROOM TEMPERATURE

 

OUTSIDE TEMPERATURE

 

HEATING/COOLING SOURCE

 

 

 

PROXIMITY OF CHILD TO HEAT/COOLING SOURCE

 

 

 

 

 

 

 

 

 

 

CHECKLIST FOR DISCRETIONARY COLLECTION OF EVIDENCE

 

 

 

 

 

 

Clothing

 

Medicines

Baby Bottles

 

 

Toys

 

Bedding

 

Drug Paraphernalia

Formula/Food

 

 

Equipment

 

Diapers

 

Folk Remedies

Honey, if fed within 30 days

Other

 

 

 

 

 

 

 

 

 

 

 

 

TRACE EVIDENCE COLLECTED: LIST

 

LOCATION FOUND

 

 

DISPOSITION AND PRESENT LOCATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHOTOS TAKEN?

 

 

 

 

 

 

 

 

 

 

 

 

NO

YES

If yes, by whom?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALL WITNESSES, RESPONDERS, AND OTHER PERSONS AT SCENE

 

 

 

 

 

List all persons at scene during time child died.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

ADDRESS

 

 

 

RELATIONSHIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NARRATIVE (USE ADDITIONAL PAGES AS NECESSARY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

71. DATE/TIME OF INVESTIGATION

 

72. CASE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

73. INVESTIGATOR’S NAME

 

 

 

 

74. AGENCY/DEPARTMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MO 886-3228 (11-06)

File Attributes

Fact Detail
1. Purpose This form is used to guide investigations at the scene of sudden, unexplained, or suspicious child deaths.
2. Timeframe for Use The investigation should ideally take place within 24 hours after the child’s death.
3. Assistance For help with the form, individuals can call (800) 487-1626.
4. Usage of Information Information gathered helps pathologists determine the cause and manner of the child's death.
5. Investigative Approach An empathetic, non-confrontational approach is recommended for investigators.
6. Additional Documents If needed, this form can be attached to an investigation report and submitted to the Medical Examiner’s Office prior to the autopsy.
7. Reconstruction Efforts The use of dolls or silhouettes may be needed to reconstruct the scene and position of the body.
8. Legal Compliance Contact the Prosecuting Attorney’s Office to ensure all legal actions are properly taken.
9. Sample Forms Sample forms for guidance are available from STAT Missouri Department of Social Services.
10. Governing Law(s) The form is governed by Missouri laws and regulations regarding child fatality investigations.

How to Write Mo 886 3228

Once the unfortunate event of a child fatality occurs, especially under sudden, unexpected, or suspicious circumstances, a precise and thorough investigation of the scene is imperative. The MO 886 3228 form functions as a comprehensive guide to conducting such sensitive inquiries. Its proper completion ensures that the child's death is meticulously documented, facilitating a better understanding for the pathologist to determine the cause and manner of death. Here, detailed steps for accurately filling out this form are outlined, striving to assist in the methodical collection of all relevant information and evidence.

  1. Commence by entering the child's full name in the space designated for "CHILD'S NAME".
  2. Input the child's Social Security Number if available.
  3. Record the address of the scene where the death occurred under “SCENE ADDRESS”.
  4. Fill in the child’s date of birth followed by the date of death.
  5. Specify the race and sex of the child.
  6. Under "DECEDENT'S ADDRESS", provide the child's residence if different from the scene address.
  7. Enter the mother’s name, address, telephone number, and date of birth.
  8. Document the mother's Social Security Number.
  9. For the pre-natal history section, start with the weeks of gestation followed by the birth weight.
  10. Answer yes, no, or unknown to known maternal pre-natal health problems and describe if applicable.
  11. Indicate if the mother was taking prescription medication for any condition mentioned.
  12. Detail maternal usage of cigarettes, alcohol, or drugs during pregnancy.
  13. Address known complications of pregnancy or delivery, providing explanations where warranted.
  14. Fill in the location of birth and the name of the facility alongside the attending medical practitioner’s information.
  15. If there were any birth defects or abnormalities of the decedent at birth, describe them.
  16. Report any family history of Sudden Infant Death Syndrome (SIDS) or other infant deaths, offering details.
  17. Moving to the events surrounding death, specify the place of the fatal event and whether the death was witnessed, including narrative detail if applicable.
  18. Describe who found the child and the child’s condition when found, including the time the child was last seen alive.
  19. Document any attempts of resuscitation or if medical assistance was summoned, including 911 calls.
  20. Note if the child was conveyed to a medical facility, the name of the facility, and who pronounced the child dead.
  21. Proceed with the condition of child section, starting with body temperature, presence of rigor mortis or livor mortis, and any observed hemorrhages.
  22. Detail the cleanliness and appearance of the child, and specify any found injuries or birthmarks.
  23. Indicate the position of the child when found and sketch the position if the body is not present.
  24. Address issues like airway obstructions, materials found in nose or mouth, and the sleeping environment, including the bed’s description and objects around it.
  25. Discuss social and environmental conditions, noting with whom the child lived and the caregiver's activities prior to the death.
  26. Indicate any past reports of abuse or neglect, listing child care providers and describing the dwelling’s cleanliness and environmental conditions.
  27. Conclude with listing any potential environmental hazards and discretionary collection of evidence, including clothing, baby bottles, and any trace evidence collected.
  28. Document all witnesses, responders, and other persons at the scene at the time of the child's death.
  29. Finally, enter the date/time of investigation, case number, investigator's name, and agency/department.

After completing the MO 886 3228 form, attach it to the investigation report and submit a copy to the Medical Examiner’s Office prior to the autopsy. Given the emotional and legal sensitivities involved, ensure all information is accurately recorded and procedural guidelines are followed meticulously. This task requires not only attention to detail but also a protocol-driven approach to gather evidence crucial for understanding the tragic death of a child.

What You Should Know About This Form

What is the MO 886-3228 form used for?

The MO 886-3228 form is a critical document utilized by the Missouri Department of Social Services, specifically within the Missouri Child Fatality Review Program. Its primary purpose is to serve as a comprehensive death scene investigative checklist following the sudden, unexpected, or suspicious death of a child. This form guides investigators through a detailed examination of the scene to accurately determine the cause and manner of death, significantly aiding in the subsequent medical and legal processes.

Who should complete the MO 886-3228 form?

This form is intended for use by professionals responsible for the investigation of a child's death scene. This includes members of law enforcement, emergency medical services (EMS) personnel, child care providers, and other suitable officials who arrive at the scene. These individuals are encouraged to fill out the checklist to the best of their abilities, providing essential information for the pathologist and contributing to a thorough investigation.

When should the MO 886-3228 form be completed?

The checklist is designed to be used as soon as possible after the death of a child, optimally within the first 24 hours. Completing the investigation promptly is crucial for accurately determining the cause of death and preserving valuable evidence.

What information is required on the MO 886-3228 form?

The form requests comprehensive information, including but not limited to:

  • Victim identifiers and pre-natal history
  • Details surrounding the death
  • Condition of the child and any observed physical markings or injuries
  • Position of the child when found
  • Social and environmental conditions
  • A checklist for discretionary collection of evidence
  • Details of all witnesses, responders, and other persons at the scene
This extensive data collection aids in forming a complete picture of the circumstances leading to the child's death.

How should the investigation be conducted?

Investigators are advised to conduct the scene examination with an empathetic, non-confrontational approach. Criminality or negligence should not be immediately assumed, but the possibility should not be overlooked. The investigation should include interviews with witnesses and the collection of physical evidence, with an effort to reconstruct the scene if the child has been moved prior to the investigation.

Where should the completed MO 886-3228 form be submitted?

Once filled out, the form, along with any attached reports or additional documents, should be submitted to the Medical Examiner’s Office prior to the autopsy. It is also advised to coordinate with the local Prosecuting Attorney’s Office to ensure all procedures align with legal standards and regulations.

Is there assistance available for completing the form?

Yes, assistance is available. Investigators can call (800) 487-1626 for support in completing the form or navigating any part of the investigation process. This line can provide guidance on both the use of the checklist and general advice on conducting a child fatality scene investigation.

Are there any requirements for evidence collection?

The form includes a section dedicated to the discretionary collection of evidence, which guides investigators on what types of items might be collected from the scene for further analysis. This could include anything from clothing and bedding to toys and medicines. Additionally, it instructs on the collection of trace evidence and the documentation of such, emphasizing the importance of photos and detailed notes for the complete reconstruction of the scene. Collaboration with law enforcement is crucial to ensure that evidence is collected and documented following legal protocols.

Common mistakes

Filling out the Missouri Department of Social Services' MO 886-3228 Form, otherwise known as the Death Scene Investigative Checklist for Child Fatalities, is a critical task that requires attention to detail and thoroughness. However, individuals often encounter challenges during this process. Some common mistakes made include:

  1. Not Completing All Sections: The form is designed to capture a comprehensive overview of the circumstances surrounding the child's death. Skipping sections or providing incomplete information can hinder the pathologist's ability to determine the cause and manner of death accurately.
  2. Assuming Criminality or Negligence Prematurely: While the form does suggest not overlooking the possibility of negligence or criminality, jumping to conclusions without proper evidence can lead to biased reporting and potentially overlook vital information relevant to the case.
  3. Failure to Use Approved Procedures and Forms: The instructions emphasize the use of procedures and forms approved by one's agency and the prosecuting attorney's office. Utilizing non-approved documents or not following protocol can lead to issues in the investigation's integrity and legality.
  4. Not Recreating the Scene Accurately: Since the form requires recreating the scene to approximate actual events, inaccuracies in this reconstruction can lead to erroneous conclusions. It's crucial to rely on evidence and witness accounts to ensure the scene is depicted accurately.

Besides these particular mistakes, there are several other areas where errors are commonly made:

  • Omitting Victim Identifiers and Pre-natal History: Every detail, from the child's social security number to the mother's health condition during pregnancy, contributes to understanding the child's background and any factors that might have contributed to their death.
  • Inadequate Detail in Describing the Scene and Events: The sections requiring descriptions of the environment and events leading up to the death are often underutilized. These narratives provide context that could be critical in determining the death's nature.
  • Not Collecting or Recording Evidence Properly: Whether it's clothing, toys, or environmental conditions, failing to collect or note these items can leave gaps in the investigation. Every piece of evidence, no matter how seemingly insignificant, has the potential to be crucial.
  • Overlooking Witnesses and Other Responders: Neglecting to thoroughly document all individuals present at the scene or involved prior to the investigator's arrival can result in missing vital testimonies and perspectives that may shed light on the case.

By addressing these common mistakes, individuals tasked with completing the MO 886-3228 Form can ensure a more accurate and comprehensive investigative process, supporting the essential work of determining causes and contributing to the prevention of child fatalities.

Documents used along the form

When dealing with the complexities and emotional weight of child fatality cases, professionals often utilize a variety of forms and documents to ensure a thorough investigation and to care for the sensitivity of the situation. The MO 886-3228 form, focusing on death scene investigation for child fatalities, serves as a crucial tool in this process. Alongside this form, several other documents are integral in piecing together the narrative and facts surrounding such unfortunate events.

  • Autopsy Request Form: This document is vital for initiating an autopsy, detailing specific requests for examination and tests needed to determine the cause of death. It includes the deceased child's personal information and preliminary findings from the death scene investigation.
  • Child Welfare Agency Referral or Report Form: In cases where neglect or abuse might have contributed to a child's death, a referral or report form to child welfare services is necessary. This form reports concerns or evidence of abuse or neglect for further investigation by child protective services.
  • Medical Records Release Form: Access to the deceased child’s medical history is crucial for understanding health conditions or prior medical concerns that might relate to the cause of death. This form authorizes health care providers to release medical records to investigating authorities.
  • Family Interview Guide: This structured guide helps investigators conduct sensitive interviews with grieving family members. It helps gather crucial information about the child’s health history, family dynamics, and circumstances leading to the death, while also providing needed support to the family.

In gathering a complete picture of a child's passing, these documents and forms complement the MO 886-3228 checklist by enhancing understanding, guiding investigations, and ensuring compassionate interaction with affected families. Together, they form a comprehensive approach to addressing the multifaceted nature of child fatality investigations, balancing the need for thorough inquiry with the respect and care for those grieving.

Similar forms

The MO 886 3228 form is detailed and highly specialized, focusing specifically on the tragic circumstance of child fatalities. It bears similarities to other investigative forms used in sensitive cases, such as the Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF) and the Child Abuse and Neglect Reporting Form (CANRF). These documents, though each serves a distinct purpose, overlap in their meticulous approach to gathering comprehensive details about incidents, emphasizing the investigative process, evidence collection, and witness interviews to ensure a thorough understanding of the circumstances surrounding a case.

The Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF) is particularly comparable in its structure and intent. Like the MO 886 3228 form, it is utilized in the wake of an infant's unexpected death, guiding investigators through a comprehensive examination of the scene, the infant’s medical history, and circumstances leading up to the death. Both forms underscore the importance of capturing exhaustive details to aid in determining the cause of death. They stress the significance of scene recreation, witness interviews, and the collection of medical and environmental information. Where they converge is in their shared goal of piecing together a narrative that accurately reflects events surrounding the death, thereby illuminating potential causes.

Meanwhile, the Child Abuse and Neglect Reporting Form (CANRF) shares the MO 886 3228 form’s commitment to meticulous data collection in distressing circumstances. Although the CANRF focuses on cases of suspected abuse and neglect, parallel to the death scene investigative checklist’s focus on fatalities, both require detailed documentation of physical symptoms, environmental factors, and caregiver accounts. Each form represents a crucial component of a broader investigative process, where the primary objective is to safeguard vulnerable populations by ensuring that accurate, thoroughly researched information guides subsequent actions and interventions. Through careful documentation, both forms contribute significantly towards understanding and preventing future tragedies.

Dos and Don'ts

When filling out the MO 886-3228 form, which is utilized for the Missouri Child Fatality Review Program, attention to detail and thoroughness are paramount. Here are some key dos and don'ts to guide you through the process:

  • Do:
  • Ensure that all available sections that apply to the fatality are completed to aid in determining the cause of death.
  • Contact the provided hotlines for assistance if you encounter any difficulties during the process.
  • Conduct interviews with witnesses and individuals involved in the child’s care and emergency response to gather comprehensive information.
  • Attach the completed checklist to your investigation report and submit it to the Medical Examiner’s Office before the autopsy as required.
  • Recreate the scene accurately, using dolls or silhouettes if necessary, to support the pathologist in determining the cause of death.
  • Collect all necessary evidence, including photos of the scene and any objects that could have influenced the death, following proper legal procedures.
  • Don’t:
  • Assume criminality or negligence without evidence, but remain open to all possibilities throughout the investigation.
  • Leave any sections incomplete if the information is available and applicable to the case.
  • Delay the investigation; strive to begin within 24 hours after the child’s death to ensure evidence and memories are as fresh as possible.
  • Forget to contact the Prosecuting Attorney’s Office to confirm you are following all legal procedures during the search, interview, and collection phases.
  • Use unauthorized forms or procedures not approved by your agency and prosecutor.
  • Overlook the importance of securing scene and reconstruction photographs, as they can be crucial in understanding the circumstances leading to the child's death.

Misconceptions

Understanding the MO 886 3228 form, used for child fatality scene investigations in Missouri, can sometimes be confusing. Here's clarifying some common misconceptions:

  • It's only for law enforcement use: While it's primarily used by professionals investigating child fatalities, the form is also intended for guidance to ensure a thorough scene investigation, which can include various agencies.

  • It determines the cause of death: The form is a tool for gathering evidence at the scene. Determining the cause of death is the job of medical professionals during the autopsy, though this form helps in that determination.

  • The form is optional: Completing the MO 886 3228 is a critical step in investigating child fatalities. Its use helps ensure all relevant details are considered and properly documented.

  • It's to be used for children of all ages: Specifically, it is designed primarily to guide investigations involving children under one year old or in cases of sudden, unexplained, or suspicious child deaths.

  • It’s for assessing parental responsibility: The focus of the form is to collect detailed information about the death scene, not to immediately assign blame or assess parental negligence.

  • Scene recreation is not mandatory: If the child has already been moved, recreating the scene as accurately as possible, including the use of dolls or silhouettes, is a crucial part of the investigation process.

  • The form is completed at the scene: While it's initiated at the scene, finishing it may require additional information from interviews, medical records, or autopsy findings.

  • All questions must be answered: It's understood that not all questions on the form will apply to every situation. The goal is to complete as much relevant information as possible.

  • You must personally perform all tasks listed: The form outlines a comprehensive investigative process, including interviews and evidence collection. While not all tasks may fall directly on the person completing the form, coordinating with other professionals is part of the process.

  • Submitting the form to the Medical Examiner's Office is the final step: In addition to submission, the investigator should ensure all procedures and laws have been followed and coordinate with the Prosecuting Attorney's Office as needed.

Correct understanding and application of the MO 886 3228 form is crucial in ensuring the careful and thorough investigation of child fatalities, ultimately helping to determine the cause and manner of death and potentially preventing future tragedies.

Key takeaways

When facing the challenging task of investigating child fatalities, the MO 886 3228 form serves as an essential guide, designed to ensure a comprehensive analysis of the death scene. Here are ten key takeaways to consider while utilizing this form:

  • Timeliness is crucial: Investigations should commence as swiftly as possible, ideally within 24 hours after the child's death to ensure evidence and memories are as fresh as possible.
  • Completeness is key: Filling out as many sections of the form thoroughly ensures pathologists receive the necessary information to accurately determine the cause and manner of death.
  • Interviews are foundational: Speaking with witnesses, EMS, emergency room personnel, child care providers, law enforcement, and others present at the scene or with knowledge of the incident provides critical insights.
  • Approach matters: Conducting the investigation with empathy and without confrontation encourages more cooperation and candid sharing of information.
  • Documentation enhances accuracy: Attaching the completed checklist to the investigation report and submitting a copy to the Medical Examiner’s Office prior to the autopsy help paint a complete picture of the circumstances surrounding the death.
  • Reconstruction aids understanding: Recreating the scene, especially when the child has been moved, is vital for understanding the events leading to the death. The use of dolls or silhouettes for reconstruction and obtaining photographs can be incredibly helpful.
  • Legal compliance is non-negotiable: Coordinating with the Prosecuting Attorney’s Office ensures the investigation adheres to all relevant laws and regulations, particularly in the collection of evidence and conducting searches and interviews.
  • Victim details provide context: Recording extensive information about the child, including pre-natal history and any relevant family history of similar incidents, offers crucial context for determining the cause of death.
  • Analysis of the death scene offers clues: Detailed examination of where and how the child was found, including the sleeping environment and any objects that could have influenced the death, are critical for forming a clear understanding of potential causes.
  • Environmental and social factors matter: Assessing the living conditions, caregivers’ actions around the time of death, and any environmental hazards in or around the dwelling can reveal risk factors or direct causes of the fatality.

By adhering to these guidelines when completing the MO 886 3228 form, investigators can ensure a thorough and sensitive approach to the tragic event, aiding in the accurate determination of the cause and manner of death, and hopefully, contributing to the prevention of future tragedies.

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