For questions regarding community- based residential facilities, you may contact the Bureau of Assisted Living, Division of Quality Assurance.
- CBRF Initial License Application, F-60287 (PDF)
- Free-Standing CBRF Plan Approval Application, F-62496 (PDF)
- Assisted Living Facility Request for Waiver, Approval, Variance or Exception, F-62548 (PDF)
- Community-Based Residential Facility - Residents' Rights Complaint Report, F-62430 (PDF)
- Community-Based Residential Facility (CBRF) Resident Satisfaction Evaluation, F-62372 (PDF)
- Fire Inspection Community-Based Residential Facility (CBRF), F-60795 (PDF)
- Resident Evacuation Assessment, F-62373 (PDF)
- Self Supervision Evaluation & Waiver Request, F-60309 (PDF)
- Significant Change in Health Screening Instrument, F-62370 (PDF)
- Waiver of Hospice or Home Health Services by a Terminally Ill CBRF Resident, F-62369 (PDF)
Construction/Remodeling of Health Care Facilities - Plan Review Requirements (including forms)
Wisconsin Client Rights and Grievance Procedure - includes forms
All fires in a licensed CBRF in Wisconsin must be reported to the Department of Health Services within 3 working days.
- All fires are to be reported by completing and submitting the online Health Care Facility Fire Report, F-62500.
Questions about this process may be directed to the "Fire Authority" at 608-266-8016. Refer to DQA memo 17-003 (PDF) for additional information.