Report a Facility Incident

To report an incident, complete the Reportable Incident Form for Certified, Licensed or Registered Providers (PDF) and submit it to the Division of Licensing & Certification using one of the following options:

Option 1: Fax: (207) 287-9307 - Augusta District Office

Option 2: Mail:

  • Division of Licensing and Certification
  • 11 State House Station
  • 41 Anthony Avenue
  • Augusta Maine 04333

To promote consistency and save your staff some time, providers may want to pre-fill the form with the facility’s name, address, and other information that remains the same and save a copy of your pre-filled incident form for future use.

Alternatively, you may choose to report an incident online using the form below.

Option 3: You may choose to report an incident online.