INCIDENT REPORT FORM (for UI or MUI) 2025

Show details

4.8 out of 5

111 votes

The document is an Incident Report Form used by the Ashtabula County Board of Developmental Disabilities to document unusual incidents (UI) or major unusual incidents (MUI) involving individuals with developmental disabilities. It includes sections for detailing the incident, types of incidents, injuries, witnesses, immediate actions taken, notifications made, and follow-up reports from nurses and administrators.

Here's how it works

01. Edit your mui report form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send unusual incident examples via email, link, or fax. You can also download it, export it or print it out.

How to modify INCIDENT REPORT FORM (for UI or MUI) in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Working on paperwork with our feature-rich and user-friendly PDF editor is straightforward. Follow the instructions below to fill out INCIDENT REPORT FORM (for UI or MUI) online easily and quickly:

Sign in to your account. Sign up with your email and password or register a free account to try the product before upgrading the subscription.
Import a document. Drag and drop the file from your device or add it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit INCIDENT REPORT FORM (for UI or MUI). Effortlessly add and underline text, insert pictures, checkmarks, and symbols, drop new fillable fields, and rearrange or remove pages from your paperwork.
Get the INCIDENT REPORT FORM (for UI or MUI) completed. Download your modified document, export it to the cloud, print it from the editor, or share it with others through a Shareable link or as an email attachment.

Benefit from DocHub, one of the most easy-to-use editors to promptly handle your paperwork online!

See more INCIDENT REPORT FORM (for UI or MUI) versions

We've got more versions of the INCIDENT REPORT FORM (for UI or MUI) form. Select the right INCIDENT REPORT FORM (for UI or MUI) version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (111 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can I sign my [KEY] electronically?

As outlined by eSignature laws, forms signed electronically have the same validity as those approved with pen and paper. You can electronically sign almost any business and private documentation. Four types of paperwork still demand handwritten signatures only - wills and testamentary trusts, court orders and other court papers, state statutes governing divorce, adoption, or other family law, and notice of cancellation of utility services. If you follow the regulations and utilize a secure and compliant software solution, like DocHub, you can eSign your [KEY] without printing it.

What browser do I need to edit [KEY] online?

If you want to edit your [KEY] on the internet quickly, it does not matter what web browser you employ. DocHub’s simple editing instruments are accessible using any internet browser. Simply open the appropriate tab in the editor, add your document, and fill it out without stress.

How many categories of MUI are there?

There are nineteen types of incidents defined in the rule that are considered major unusual incidents.

What is an example of an unusual incident?

Unusual Incident means incidents involving serious illness or accidents, death of an individual, injury or illness of an individual requiring inpatient or emergency hospitalization, suicide attempts, a fire requiring the services of a fire department, an act of physical aggression, or any incident requiring abuse ...

Which Mui types are required to be reported within 4 hours?

Notification to the County Board about the below listed incidents within 4 hours of discovery: Accidental or suspicious death; Exploitation; Misappropriation; Neglect; Peer-to-peer act; Physical abuse; Prohibited sexual relations; Sexual abuse; Page 2 Verbal abuse; and When the provider has received an inquiry from the ...

mui dodd

Incident report form for ui or mui pdf Incident report form for ui or mui online

What is a MUI charge?

Younger drivers can be arrested and charged with a minor under the influence (MUI) offense under Georgia's zero tolerance law. If your test shows a level one-quarter of the legal limit for those over the age of 21, just 0.02%, the state could charge you with an MUI.

Is a medical emergency a MUI or UI?

All Category B MUIs (attempted suicide, death other than accidental or suspicious death, medical emergency, missing individual, and significant injury) require an administrative investigation that meets the requirements outlined in Appendix B of the MUI Rule.

What is the first thing you should do when an MUI or UI occurs?

Immediately upon identification or notification of an MUI, a service provider shall, first and foremost, take all reasonable measures to ensure the health and safety of individuals who are at risk.

What is considered an MUI?

A Major Unusual Incident (MUI) is defined as any alleged, suspected, or actual occurrence of an incident that adversely affects the health and welfare of an individual receiving services from the County Board. There are nineteen types of incidents defined in the rule that are considered major unusual incidents.

What is considered an unusual incident?

More Definitions of Unusual Incident Unusual Incident means an event or occurrence involving an individual that is not consistent with routine operations, policies and procedures, or the individual's care or service plan, but is not a major unusual incident.