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Wisconsin Department of Health Services

If You Have Complaints about Wisconsin Health Care

Information about Division of Quality Assurance (DQA)

Provider Types Regulated by DQA

DQA Listservs

Provider Search

Provider Training

DQA Numbered Memos

DHS Forms

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

  • Fire Report form DQA F-62500 (Word, 78 KB) - Fillable form with contacts to assist the reporting of fires in a healthcare facility.
  • Fire Watch memorandum DQA 12-013 - Outlines the minimum procedures for when a required sprinkler or fire alarm system is out of service.

  • 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: August 21, 2012