24 hour report 2025

1. Click ‘Get Form’ to open the 24-hour report in the editor.
2. Begin by filling out the Provider Information section. Enter details such as Facility/Provider Type, County, and Facility/Provider Name. Ensure all required fields are completed accurately.
3. In the Actual Incident section, provide the Location Address and select the Allegation/Incident Type. Check all applicable boxes related to resident abuse or neglect.
4. Detail the Allegation Description, including the Incident Date and Time. Describe any physical or mental injuries sustained by residents.
5. Complete the Resident Information section with full name and date of birth. Specify their type of care/service and setting.
6. Fill in Accused Individual Information, including their full name, date of hire, job title, and contact information.
7. Indicate whether there is a reasonable suspicion of a crime and if law enforcement has been notified. Provide details as necessary.
8. Finally, print your name and title at the bottom of the form before signing and dating it to complete your submission.

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