Report a Facility Incident

Note: This guidance is for employees of a facility, agency, or center who wish to report an incident on behalf of the facility, agency, or center only. See page File a Complaint for guidance if you are not an employee of the facility, agency, or center of if you are an employee but wish to file an incident as an individual and not on behalf of the facility, agency, or center.

To report an incident, please complete the online form.  

Report a Facility Incident


Please use “Report an Incident at a Facility, Agency, or Center” when responding to the question “Which type of report do you wish to submit?”

If you are unable to file an online report, please complete:  

Reportable Incident Form for Certified, Licensed or Registered Providers (PDF) 

Then submit via one of the following options:

Option 1: Email

Option 2: Fax: 207-287-9307