Adult Programs
Wisconsin Caregivers - Complaints

All entities regulated by the Division of Quality Assurance (DQA) must:

• Immediately protect clients from subsequent incidents of caregiver misconduct

• Investigate all allegations of caregiver misconduct

• Document the results of their investigation

• Report allegations/incidents to DQA as appropriate

All entities except nursing homes:

DQA Memo 04-028, Revised Caregiver Misconduct Reporting Requirements for DQA Entities

• Use the Worksheet or Flow Chart to assist in making the reporting determination.

• Use the DDE-2447 Incident Report form (below) to report misconduct allegations.

Nursing Homes Only:

OQA memo 05-004, Requirements for Reporting Allegations of Abuse, Neglect, Misappropriation, Injuries of Unknown Source

DQA memo 05-012, UPDATE - Requirements for Reporting Allegations of Abuse, Neglect, Misappropriation, Injuries of Unknown Source

• Use the DDE-2617 Alleged Nursing Home Resident Mistreatment, Neglect and Abuse Report for 24-hour notification.

• Use the DDE-2447 Incident Report form to report misconduct allegations.

For allegations involving all staff (noncredentialed and credentialed), submit the Incident Report to DQA at:

Department of Health & Family Services
Division of Quality Assurance
Office of Caregiver Quality
PO Box 2969
Madison, WI 53701-2969

Note: In the past, you were required to submit the report either to DQA or to the Department of Regulation and Licensing (DRL). This process has been streamlined to eliminate reporting to two different agencies. 

All caregiver misconduct reports are submitted to DQA, who will report reports involving credentialed staff (doctors, RNs, LPNs, social workers, etc.) to DRL for review.

Forms:

• Incident Report of Caregiver Misconduct and Injuries of Unknown Source (PDF version), DDE-2447 (PDF, 136 KB)

  • Incident Report of Caregiver Misconduct and Injuries of Unknown Source (Word version), DDE-2447 (Word, 153 KB)

• Caregiver Misconduct Reporting Requirements Worksheet (PDF, 39 KB)

• Alleged Nursing Home Resident Mistreatment, Neglect and Abuse Report (PDF version), DDE-2617 (PDF, 18 KB)

  • Alleged Nursing Home Resident Mistreatment, Neglect and Abuse Report (Word version), DDE-2617 (Word, 52 KB)

• Flowchart (PDF, 20 KB) for Investigating and Reporting Caregiver Misconduct or Injuries of Unknown Source

PDF: The free Acrobat Reader^® software is needed to view and print portable document format (PDF) files. Learn more.

Last Revised: June 30, 2008