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Resident Forms

Resident Forms

Forms marked with a (*) are required and must be used unless prior written approval for a specific substitute form has been granted. All other forms on this page are intended to assist the licensee in demonstrating compliance with the record keeping requirements specified in the Adult Foster Care Licensing Rules. It is the responsibility of the licensee to copy and distribute each form as specified by statute.

Fire Safety

As an alternative to using the above Evacuation Score forms from 1985 which are required by R 330.1803, the department will accept the 2012 Life Safety Code Form “Worksheets for Determining Evacuation Capability”.  This version allows the user to fill them out electronically.   
Worksheets for Determining Evacuation Capability