Nursing Homes - Forms

For questions regarding nursing homes, you may email the Division of Quality Assurance

Fire Reporting

Fire Report, F-62500 (Word,) - Fillable form with contacts to assist the reporting of fires in a healthcare facility.

Fire Watch memorandum DQA 17-003 (PDF) - Fire Watch, Fire Plan, and Fire Reporting.


A Pre-admission Screen and Resident Review (PASARR) Level 1 Screen must be completed prior to admission to a nursing facility admission to determine if a person reasonably is suspected of having a serious mental illness or a developmental disability, which necessitates a PASARR Level II Screen prior to admission unless a short-term exemption, per Wisconsin PASARR policies, is appropriate

Pre-admission Screen and Resident Review (PASARR) Level 1 Screen, F-22191 (Word)

Plan Review

Construction/Remodeling of Health Care Facilities: Plan Review Requirements

Last Revised: April 4, 2017