The DHS-1910 Incident Report Form is explicitly created for use by DHS contracted or licensed providers. This document ensures that incidents involving clients under the care of various DHS programs are systematically reported.
The form includes several sections where specific information must be filled out, such as:
- Type of report (initial, follow-up, or final)
- Details of the incident (date, time, location, and nature of the incident)
- Notifications made to various parties (e.g., Adult Protective Services, law enforcement)
It also provides space for a narrative description of the incident, allowing the reporter to detail the events leading up to and following it. This way, all relevant factors are considered in any subsequent investigation or review. The form helps maintain safety, accountability, and compliance within DHS-operated or affiliated programs.
| Question | Answer |
|---|---|
| Form Name | DHS Form Incident Report |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 70 |
| Avg. time to fill out | 12 min |
| Other names | incident report applicable sample, incident form applicable print, DHS incident report form Arkansas, DHS form incident report |