1. (a) Licensees shall ensure that program staff complete all reports and comply with reporting requirements for uses of restraint and seclusion, in accordance with RSA 126-U and He-C 901.
2. (b) For other incidents defined in He-C 4001.01(z) the licensee shall complete a legible, written incident report.

3. (c) For incidents described in (b) above, the report required shall include:

   1. (1) The program name;
   2. (2) A description of the incident, including what led to the incident, where it occurred, and identification of injuries, if applicable;
   3. (3) The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;
   4. (4) The name of resident(s) involved in or witnessing the reportable incident;
   5. (5) The date and the beginning and ending time of the reportable incident;
   6. (6) The action taken in direct response to the reportable incident, including any follow-up;
   7. (7) If medical intervention was required, by whom, and the date and time;
   8. (8) When the resident’s guardian, agent, surrogate decision-maker, or personal representative, if any, was notified;
   9. (9) The signature of the person reporting the reportable incident; and
   10. (10) The date and time the resident’s licensed practitioner was notified, if applicable.
4. (d) If the incident is a reportable incident as defined in He-C 4001.01(bb), the program shall notify the unit within 48 hours of the incident.
5. (e) Incident reports shall be maintained as part of the involved resident’s records and be made available on the premises of the program for review by the department.
6. (f) Program staff shall provide the resident’s parent(s) or guardian(s) with information regarding incident reports on the next business day, which shall include all of the information included on the incident report.
7. (g) If the parent(s) or guardian(s) do not have a telephone or cannot be reached, program staff shall document their efforts to notify them and send a written copy of the incident report to the parent(s) or guardian(s).
8. (h) For uses of seclusion, restraint, or other intentional physical contact with a child which is response to a child’s aggression, misconduct, or disruptive behavior, program staff shall notify the resident’s parents or guardians in accordance with RSA 126-U and He-C 901.
9. (i) Immediately following any fire or emergency incident, licensees shall notify the unit by phone, followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

10. (j) The written notification required by (i) above shall include:

    1. (1) The date and time of the incident;
    2. (2) A description of the location and extent of the incident, including any injuries or property damage;
    3. (3) A description of events preceding and following the incident;
    4. (4) The name of any personnel or residents who were evacuated as a result of the incident, if applicable;
    5. (5) The name of any personnel or residents who required medical treatment as a result of the incident, if applicable; and
    6. (6) The name of the individual the licensee wishes the unit to contact if additional information is required.
11. (k) As soon as is practicable but no longer than 24 hours after the use of a medication restraint, the resident’s licensed practitioner shall be notified of the use of such restraint.
12. (l) Program staff shall immediately notify the local police department, the unit, and the resident’s parent or guardian when a resident is unaccounted for after searching the buildings and grounds, and determining that the resident is a danger to their self or others, or the resident is in danger because of the current weather conditions or season.
13. (m) The program director or designee shall notify the unit, the parent or guardian, and the person or agency responsible for the resident’s placement within 24 hours of the serious injury or death of any resident.
14. (n) In the event of the death of a resident, the program director or designee shall provide a written report to the unit and the person or agency responsible for the resident’s placement, within 72 hours of the death, detailing the circumstances of the death.

Source. #2664, eff 3-30-84, EXPIRED: 3-30-90 New. #8581, eff 4-20-06, EXPIRED: 4-20-14 New. #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20; amd by #13991, EMERGENCY RULE, eff 5-29-24, EXPIRED: 11-25-24 New. #14123, eff 11-26-24, EXPIRED: 11-26-25; ss by #14214, eff 4-1-25, EXPIRES: 4-1-35