Required Format for Incident Documentation Submissions

Licensee Census Form in Microsoft® Word

Policy and Procedure Certification in Microsoft® Word

Staff Training Certification in Microsoft® Word

Appendix 4 Incident Reporting Form in Microsoft® Word

Providers must use this form to report each serious reportable incident to OHCQ.

Appendix 5 Quarterly Incident Report Form in Microsoft® Word

Providers must use the Quarterly form to report behavioral incidents to OHCQ. The quarterly form must be submitted to OHCQ within 15 days of October 15, January 15, April 15, and July 15 of each year.

See also: Developmental Disabilities Administration