Resource Forms (Sample Documents)

911 - Procedure and Policy

Alarm Consent

Admission Agreement Private Pay

Aggressive Behavior Intervention

Adult Family Home Checklist

This checklist is designed to assist the applicant in preparation for the initial inspection.

Abuse & Neglect Policy

Controlled Substance List

L & I - Signature Page

Transfer Pole Informed Consent Release

Hotline Poster (DSHS)

TB Risk Assessment & Questionnaire

Employee Paid Sick Leave Notification Form

Levels of Care

SOAP Charting

Elopement Prevention

Disclosure of Services Instructions (DSHS)

Side Rail Trapeze Assessment Consent

Death of a Resident Procedure

Safety Alarm Evaluation

Consent for Emergency Medical Treatment

Resident Safety Action Plan

Bed Rail Safety Consent Form

Record of Resident Death

Disclosure of Services (DSHS)

Private Transportation Consent

Hoyer Lift Policy and Procedure

Positioning - Transferring Devices Policy

Move In Checklist

Photography Consent

Medication Policy

Personnel Policies

Medication Leave of Absence Policy

Personal Inventory List

Medication Error Report

Paid Sick Leave Policy

Medication Disposal Policy

CARE Assessment Tool (DSHS)

Notice of Transfer or Discharge Form

Medication Disposal Form

Employee Request For Paid Sick Leave Form

Bed Rail Brochure (DSHS)

Trapeze Assessment & Informed Consent

Medication Assistance Nurse Delegation Consent

Advance Directive Policy (DSHS)

Written Change in Cost Notification - Hospice

Medical Information Release Form

L & I - Sharps Injury Log

Medicaid Policy

L & I - Safety Meeting Notes

Locked Door Consent

L & I - OSHA's Form 300 - Log of Work-Related Injuries and Illnesses

Lifting and Positioning Training Manual

L & I - Hepatitis B Declination Documentation

L & I - Hazardous Drug Program Guide

L & I - Blood Born Pathogens Slides

Employee Hiring Process Orientation Checklist

Bloodborne Pathogens L&I Online Course

Employee training on the hazards of Bloodborne Pathogens in the workplace

Hepatitis B Declination Documentation

Written Change in Cost Notification

New Hire Application

Narcotics Count

Form W-4 - Employment

Disclosure of Charges (DSHS)

Form I-9 - Employment