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AFC Licensing Division Incident/Accident Report

METHODS FOR SUBMITTING AN INCIDENT REPORT UPON THE 
DEPARTMENT’S REQUEST:

  1. Submit Incident/Accident Report using the online form.
  2. Submit Incident/Accident Report using the fillable form by mail, fax or email to the licensing staff member requesting the report.

 

LICENSING RULES FOR AFC HOMES

R 400. Incident notification, incident records.

Rule 693.
(1) If a resident has a representative identified in writing on the resident’s care 
agreement, a licensee shall report to the resident's representative within 48 
hours after any of the following: 
    (a) Unexpected or unnatural death of a resident.

    (b) Unexpected and preventable inpatient hospital admission. 

    (c) Physical hostility or self-inflicted harm or harm to others resulting in 
    injury that requires outside medical attention or law enforcement 
    involvement. 

    (d) Natural disaster or fire that results in evacuation of residents or 
    discontinuation of services greater than 24 hours. 

    (e) Elopement from the home if the resident’s whereabouts is unknown. 

(2) If an elopement occurs, staff shall conduct an immediate search to locate 
the resident. If the resident is not located within 30 minutes after the 
elopement occurred, staff shall contact law enforcement.

(3) An incident must be recorded on a department-approved form and kept 
in the home for a period of not less than 2 years. 

(4) The department may review incident reports during a renewal inspection 
or special investigation. This does not prohibit the department from 
requesting an incident report if determined necessary by the department. If 
the department does request an incident report, the licensee shall provide 
the report in electronic form within 24 hours after the request. The 
department shall maintain and protect these documents in accordance with 
state and federal laws, including privacy laws.

  

AUTHORITY: P.A. 218 of 1979.
COMPLETION: Is Required
CONSEQUENCE: Violation of Adult Foster Care Administrative Rule

LARA is an equal opportunity employer/program.