Get Lic802 Form

The Lic802 Form is designed to document complaints received in the licensing office of the California Department of Social Services. This guide provides clear and detailed instructions to assist users in completing this form online, ensuring a smooth and efficient filing process.

Follow the steps to accurately complete the Lic802 Form

1. Click ‘Get Form’ button to obtain the Lic802 Form and open it in your preferred online environment.
2. Fill in the complainant name and indicate how the complaint was reported — choose between options such as in person, by letter, or by telephone.
3. Provide detailed facility information, including the facility name, address, type of facility, and contact numbers for both day and evening.
4. Indicate your relationship or involvement with the facility and specify if an abuse report was required and filed.
5. Choose whether you wish to remain anonymous by selecting yes or no.
6. Outline the nature of the complaint, separating specific allegations and assigning the relevant complaint codes provided.
7. Document the details of the allegation(s) or description of incident(s), ensuring all information is clear and comprehensive.
8. Record any pre-investigation and post-investigation contact with the complainant, including dates, persons contacted, and methods of contact.
9. Summarize any other contacts or reports related to the complaint, adding any necessary comments.
10. Finally, obtain the licensing evaluator's and supervisor's signatures and dates to finalize the form.

Take the next step in safeguarding the community by completing the Lic802 Form online.