Site Reviews
Training Matrix

Incident Reports
Please be as thorough as possible when completing incident reports. MDHHS has two very specific areas that are reviewed during site reviews and audits:

  • Name of Employee assigned to recipient at time of incident:______________________
  • Indicate program or administrative action taken, including disciplinary action, to remedy and/or prevent recurrence of incident:_______________

If you are using the most current form, they are the highlighted questions at the bottom.   If you are using the Licensing form, the two questions are highlighted below.

For the first question, “if applicable”, may be seen as optional, though MDHHS requires that it be completed.

When reporting incidents involving more than one consumer, DO NOT use the names of consumers other than the primary. When referring to another resident, use initials or the term peer/housemate.

If a home manager completes and Incident Report and they sign as “Signature of Person Completing the Report”, then their supervisor would review the IR and sign under “Signature of Licensee/etc.”

Please complete the Recipients information, ie: “Name,” “Address,” “Case Number,” “Age,” “DOB” (depending on what form you use). If we have two people with the same name, we need another piece of information to determine which is the correct customer.

“Time” and “Date of Incident” are also very important pieces of information.