Dhs self report 2026

1. Click ‘Get Form’ to open the DHS Self Report in our editor.
2. Begin by entering the facility's name, license number, address, city, state, and zip code in the designated fields. Ensure all information is accurate for proper identification.
3. Fill in the date of the report using the MM/dd/yyyy format. This is crucial for tracking purposes.
4. Select the reason for the report from the provided options. This helps categorize the incident appropriately.
5. In the 'Incident Information' section, provide details such as the date and time of the incident. Use AM/PM indicators as necessary.
6. List all individuals involved in the incident along with their relationship to either the facility or resident. This ensures clarity on who was affected.
7. Describe the incident thoroughly, including location and background information. This section is vital for understanding context.
8. Document any actions taken to ensure residents' health and safety following the incident.
9. Finally, complete your contact information and sign off on the report before submission.

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