Facility Reported Incidents (Self-Reports)

The Section for Long Term Care Regulation (SLCR) has developed two new forms for all long-term care providers to utilize when reporting Facility Reported Incidents. Providers are not required the use these forms. However, the forms will be especially helpful for certified facilities to ensure they have met the reporting requirements under F609 for the Initial Report and the Follow-Up Investigation Report.

The FRI Initial Reporting Form can be sent to the Adult Abuse and Neglect Hotline fax number (listed on the form) or to the regional office.

The FRI Follow-Up Investigation Form will be sent directly to the regional office.

**Please note: Information sent via email is not secure unless it is encrypted. Sending the FRI Initial Reporting Form to the fax number at the Adult Abuse and Neglect Hotline or the regional office will ensure the information is secure.