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Wisconsin Department of Health Services

If You Have Complaints about Wisconsin Health Care

Information about Division of Quality Assurance (DQA)

DQA Web Pages Information

Provider Types Regulated by DQA

DQA Listservs

Consumer Information

DQA Facility Directories

DQA Provider Training

DQA Numbered Memos

DHS Forms

Construction/
Remodeling of Health Care Facilities

WI Nurse Aide Training and Registry Info

Caregiver Program/ Background Checks

WI Adult Programs Caregiver Misconduct Registry

Residential Care Apartment Complexes - Forms

Introduction | Rules_&_Regulations | Forms | Providers |
Contacts | Publications | Related Sites


Questions regarding residential care apartment complexes:
call the Division of Quality Assurance Regional Offices
or E-mail the Division of Quality Assurance

The first four 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-62380 (PDF, 73 KB): Residential Care Apartment Complex Certification or Registration Application

  • F-62381 (PDF, 47 KB): Residential Care Apartment Complex Regulations Compliance Statement

  • F-62548 (PDF, 17 KB): Assisted Living Facility Request for Waiver, Approval, Variance or Exception

  • F-62500 (PDF, 23 KB): Fire Report form - To report fires in a facility.

  • Fire Watch Procedure Template - To use in establishing a Fire Watch procedure any time the fire protection/ fire alarm system is taken out of operation.

  • Construction/Remodeling of Health Care Facilities - Plan Review Requirements (including forms)

  • See the Wisconsin Caregiver Program site for forms and information regarding background checks.

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Last Updated: February 25, 2009