Get Facility Suspected Crime Report Under Elder Justice Act - Kahcf

If you suspect a crime has occurred involving a resident of your facility, it is essential to complete the facility suspected crime report under the elder justice act. This guide will assist you in filling out the form accurately and submitting it in a timely manner.

Follow the steps to complete the report effectively.

1. Press the ‘Get Form’ button to access the facility suspected crime report and open it in your preferred online editor.
2. Begin by entering the details of your facility in the designated sections, including the facility name, address, phone number, fax, and email address.
3. Indicate whether you have reported the incident to the state survey agency by selecting 'Yes' or 'No.' If 'Yes,' provide the date and time of the report.
4. Fill in the contact information for the state survey agency, including their address, phone number, fax, and email.
5. Next, indicate whether local law enforcement has been notified. Similar to the previous step, provide the date and time if you selected 'Yes.'
6. Complete the contact information for local law enforcement, including address, phone number, fax, and email.
7. In the summary section, detail the suspected crime involving the resident, including their name, date of birth, location of the incident, and individuals involved. Attach any additional sheets if needed.
8. Specify if there was serious bodily injury. Choose 'Yes' or 'No' to indicate the nature of the incident.
9. Document the names of all individuals reporting the suspected crime on behalf of the facility along with the date and time they became aware of the incident.
10. Once you have completed all fields, review the information for accuracy. Save your changes, download, or print the form as necessary for submission.

Complete the facility suspected crime report online to ensure timely reporting and compliance with the elder justice act.