Web Application Template
Division of Health Care Quality - LTCRP - Incident Reporting Application

Incident Reporting Start:

  • Enter your Facility Web Code provided by the Division.
  • Click Confirm.
  • If the Facility name and location are correct, click CONTINUE >
  • Click Create NEW Incident Report or Add Follow Up Information as desired.


 




Facility Web Code


 
  OR  



PLEASE NOTE:
  • If you are new to this application, you may want to run through our Tutorial before creating a new Incident Report.
  • To print Incident and Follow Up reports, you must have Adobe® Reader installed and any pop-up blockers disabled.
  Contact the Division toll-free at 1-877-453-0012 or fax us at 1-877-264-8516 Version 2.1.0.0