Form CCL.028 Notification of Injury, Illness or Critical Incident - Kansas

What Is Form CCL.028?

This is a legal form that was released by the Kansas Department of Health & Environment - a government authority operating within Kansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form CCL.028?A: Form CCL.028 is the Notification of Injury, Illness or Critical Incident form in Kansas.

Q: Who needs to fill out Form CCL.028?A: Providers or agencies licensed by the Kansas Department for Aging and Disability Services (KDADS) need to fill out Form CCL.028 when there is an injury, illness, or critical incident involving a resident or participant.

Q: What is the purpose of Form CCL.028?A: The purpose of Form CCL.028 is to notify KDADS of any injury, illness, or critical incident that occurs within a licensed provider or agency in Kansas.

Q: What information is required on Form CCL.028?A: Form CCL.028 requires information such as the date and time of the incident, details of the incident, the individual(s) involved, and any action taken.

Q: When should Form CCL.028 be submitted?A: Form CCL.028 should be submitted to KDADS within 24 hours of the incident or as soon as possible.

Q: Are there any consequences for not submitting Form CCL.028?A: Failure to submit Form CCL.028 in a timely manner may result in penalties or sanctions imposed by KDADS.

Q: Is there a fee associated with submitting Form CCL.028?A: There is no fee associated with submitting Form CCL.028. It is a mandatory reporting requirement for licensed providers or agencies.