Community Based Residential Facilities - Forms

For questions regarding community based residential facilities, you may contact the Bureau of Assisted Living, Division of Quality Assurance.

*Asterisks mark fillable PDF forms, select the first field to begin typing. Tab from field to field. You can print the altered document but do not expect to save it with changes.

All fires in a licensed health or residential care facility in Wisconsin must be reported to the Department of Health Services within 72 hours (check specific rule requirements).

  • You may use the Fire Report Form (Word, 78 KB) and fax to 608-267-0352. Questions about this process may be directed to the "Fire Authority" at 608-266-8016. Refer to DQA memo 15-007 (PDF, 186 KB) for additional information.

Construction/Remodeling of Health Care Facilities - Plan Review Requirements (including forms)

Wisconsin Client Rights and Grievance Procedure - includes forms

Last Revised: April 30, 2015