The Support Coordinator (SC) should complete the Critical Incident Report (CIR) and keep a copy for his/her record.
Tracking: The SC shall not enter the information regarding APS Cases aged 18-59 into the Online Tracking Incident System.
Description: Enter all information regarding the incident (i.e., Who, What, When, Where, How, et cetera).
Pages: Use as many pages as necessary, numbering, dating and signing each page.
Law enforcement: If Law Enforcement was notified, include the name of the agency, contact person, and address.
| Question | Answer |
|---|---|
| Form Name | Form OAAS-PF-10-014 |
| Form Length | 5 pages |
| Fillable? | Yes |
| Fillable fields | 232 |
| Avg. time to fill out | 39 min |
| Other names | OAAS-PF-10-014, OAAS PF 10 014, HCBS Critical Incident Report Form, CIR |
| Edition | Reissued September 2, 2014 |
| Issuing agency | Department of Health and Hospitals Office of Aging and Adult Services (OAAS) |
| Official source | Form OAAS-PF-10-014 (Rev September 2, 2014), Department of Health and Hospitals Office of Aging and Adult Services (OAAS) |
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