Adult Family Homes -
Forms
Introduction | Rules_&_Regulations
| Forms | Providers
|
Contacts | Publications
| Related Sites
For questions regarding adult family homes, you may
contact the Bureau of Assisted
Living, Division of Quality Assurance.
The first two items are fillable PDF forms - select the first field
to begin typing. Tab from field to field. You can print this
document but you cannot save it.
-
F-62548
(PDF, 17 KB): Assisted Living Facility Request for Waiver, Approval, Variance or
Exception
-
F-62500
(PDF, 11 KB): Fire Report form - To report fires in a facility.
-
F-62373
(PDF, 35 KB): Resident Evacuation
Assessment
- Fire Watch Procedure Template
(HTML) - To use in establishing a Fire Watch procedure any time the fire protection/
fire alarm system is taken out of operation.
PDF: The free Acrobat Reader®
software is needed to view and print portable document format (PDF) files.
Learn more.
Last Updated: February 19, 2009 |
