Get Bcal-4607-fillable

The BCAL-4607-Fillable is an essential form used for reporting incidents and accidents within adult foster care facilities in Michigan. This guide provides step-by-step instructions to help users accurately complete this form online, ensuring all necessary details are captured for proper documentation.

Follow the steps to successfully fill out the BCAL-4607-Fillable online.

1. Press the ‘Get Form’ button to obtain the BCAL-4607-Fillable form and open it in your chosen online editor.
2. Begin by entering the date received and the date reviewed in the respective fields at the top of the form. Also, provide the initials of the reviewer.
3. In the section labeled 'AFC Licensing Division - Incident / Accident Report', fill in the name of the facility or home and its license number.
4. Provide details about the person directly involved in the incident, including their name, address, phone number, and designated role (resident, employee, visitor).
5. If there are other individuals involved or witnesses, list their names and roles, following the same format as above.
6. In the 'Facts of the Incident' section, specify the date and time of the incident, and identify the location (e.g., kitchen, yard). Include a detailed explanation of what occurred, any injuries sustained, and actions taken by staff.
7. Document any corrective measures that have been taken to prevent recurrence of the incident, attaching additional pages if required.
8. Fill in the details of the treating physician or health care facility, including their name, phone number, and the date of care given.
9. Note any individuals who have been notified about the incident, including the notification dates and times.
10. Provide the signature of the person completing the report, along with their printed name, title, and completion date. Also include the signature and details of the licensee or their designee.
11. Finally, ensure all changes are saved, and download, print, or share the completed form as necessary.

To ensure timely compliance and proper incident reporting, start filling out the BCAL-4607-Fillable online today.