The DODD MUI incident report form is the document Ohio developmental disabilities providers and county boards use to report a Major Unusual Incident under Ohio Administrative Code 5123-17-02. You can download it from the Ohio Department of Developmental Disabilities health and welfare toolkit page, and many county boards distribute the same form through their own portals.1Ohio Department of Developmental Disabilities. Incident Report Form The form is used for both major unusual incidents and lower-level unusual incidents, so the first thing you do on it is identify which type you are reporting.
When You Need to File
Ohio Administrative Code 5123-17-02 sorts Major Unusual Incidents into three categories, and the category controls your deadlines.2Ohio Legislative Service Commission. Ohio Administrative Code 5123-17-02 – Addressing Major Unusual Incidents and Unusual Incidents to Ensure Health, Welfare, and Continuous Quality Improvement
Category A covers the most serious events: physical, sexual, or emotional abuse; neglect; exploitation; misappropriation; prohibited sexual relations between a developmental disabilities employee and someone they serve; rights code violations under Ohio Revised Code 5123.62 that create a likely risk of harm; failure to report a suspected incident; and any unexplained or unanticipated death. Every Category A incident requires both oral notification within four hours and a written report.
Category B generally covers unapproved behavioral supports, peer-to-peer acts, and significant injuries that do not rise to abuse or neglect.
Category C covers medical emergencies not addressed in an individual’s plan, attempted suicide, missing individuals, and law enforcement involvement.
Both B and C still require a written incident report on the same next-business-day timeline, but only Category A triggers the four-hour oral notification rule. A media inquiry about any MUI also triggers the four-hour oral notice.
A separate “unusual incident” (UI) category covers events that disrupt routine operations but do not meet the MUI threshold. UIs are documented internally and do not follow the same county board deadlines, though the same form can be used.
Who Is Required to Report
Ohio Revised Code 5123.61 makes reporting mandatory for all developmental disabilities employees, meaning anyone employed by or under contract with a provider, county board, or DODD who has responsibility for providing care or supervising someone with a developmental disability.3Ohio Legislative Service Commission. Ohio Administrative Code 4757-5-10 – Standards of Ethical Practice and Professional Conduct: Reporting Unethical Actions Licensed social workers, counselors, and marriage and family therapists carry the same duty under their own licensing rules. If you witness or suspect abuse, neglect, or exploitation and stay quiet, that silence is itself a Category A MUI.
Information to Gather Before You Start
Scrambling to fill in blanks after the fact is the single most common reason reports come back for revision. Ohio Administrative Code 5123-17-02 sets the minimum content, so collect all of the following before you open the form:2Ohio Legislative Service Commission. Ohio Administrative Code 5123-17-02 – Addressing Major Unusual Incidents and Unusual Incidents to Ensure Health, Welfare, and Continuous Quality Improvement
- The individual’s name and address.
- Date, time, and location of the incident.
- A description covering who, what, when, and where.
- The type and location of any injuries.
- The immediate actions taken to protect the individual and anyone else at risk.
- The Primary Person Involved (PPI): the person alleged to have committed or been responsible for the incident, and that person’s relationship to the individual.
- Names of witnesses and written statements from anyone with personal knowledge of the event.
- A notification log with the names, titles, and date/time of every party you notified.
- Medical follow-up needed or already provided.
- Your name and signature.
Write the description in plain, factual language. “Staff member pushed the individual into a wall at approximately 2:15 p.m.” is the kind of concrete detail an investigator can work with. Skip conclusions like “staff was being abusive” — that finding is for the investigative agent, not the reporter.
Filling Out the Form
The form’s fields mirror the documentation checklist above. A few practical points that save time during the county board’s initial review:
Name the provider agency clearly. Include the full agency name, certification or contract number if you have it, and the specific program or service setting where the incident occurred. County boards use this to route the report, and vague entries slow everything down.
Attach witness statements. Witnesses should write, sign, and date their own statements. If a witness is another individual receiving services, note that and describe any accommodations used to obtain the statement.
Log every notification. Record each phone call, email, or in-person report you made, with the name and title of the person you notified and the exact date and time. This log is your evidence that you met the four-hour rule.
Safety comes before paperwork. If you need to call 911, separate people, or arrange emergency medical care, do that first. The form asks what immediate protective steps you took, and a clear answer there shows the county board that you prioritized the person.
Deadlines and Where to Send It
Missing a deadline is one of the fastest ways to draw a citation during a state audit.
Four-Hour Oral Notification (Category A)
For every Category A incident, notify the county board orally within four hours of discovering the incident, using whatever method the board has specified. The same four-hour rule applies when a provider receives a media inquiry about any MUI.2Ohio Legislative Service Commission. Ohio Administrative Code 5123-17-02 – Addressing Major Unusual Incidents and Unusual Incidents to Ensure Health, Welfare, and Continuous Quality Improvement Most county boards operate a dedicated MUI intake phone line. Get that number now, before you need it.
Written Report by 3:00 P.M. the Next Working Day
For all MUIs, Category A, B, and C alike, the completed written report must reach the county board contact by 3:00 p.m. on the first working day after you become aware of the incident.2Ohio Legislative Service Commission. Ohio Administrative Code 5123-17-02 – Addressing Major Unusual Incidents and Unusual Incidents to Ensure Health, Welfare, and Continuous Quality Improvement “Working day” means Monday through Friday. An incident discovered Friday evening has a written deadline of 3:00 p.m. the following Monday. Submit in whatever format the county board directs. Many boards accept the form by email to a dedicated MUI mailbox; others require submission through DODD’s online system.
Submitting Through OhioITMS
DODD maintains the Ohio Incident Tracking and Monitoring System (OhioITMS) for statewide health and welfare incident tracking.4Ohio Department of Developmental Disabilities. OhioITMS County boards enter preliminary information into OhioITMS by 5:00 p.m. on the first working day after receiving your report, and the system assigns a tracking number used for all future correspondence about the case. If your county board asks providers to submit directly through OhioITMS, you will need login credentials from the board’s MUI coordinator.
What Happens After You Submit
Once the county board receives the report, an Investigative Agent (IA) takes over. The IA identifies what happened, what caused it, and what needs to change to prevent it from happening again.5Ohio Department of Developmental Disabilities. Investigative Agent Resources Expect the IA to contact you for additional documentation, interview witnesses, and possibly visit the service location. Cooperate fully and provide access to records; stonewalling creates its own problems.
The regulatory deadline for closing the investigation in OhioITMS is 45 working days from the date the incident report was submitted. The county board can request an extension from DODD for good cause, and DODD may require interim progress reports in those cases.2Ohio Legislative Service Commission. Ohio Administrative Code 5123-17-02 – Addressing Major Unusual Incidents and Unusual Incidents to Ensure Health, Welfare, and Continuous Quality Improvement Cases involving law enforcement often run longer because the IA may need to coordinate with police or prosecutors before finalizing findings. Outcomes range from a finding that no further action is needed to a full administrative investigation with corrective actions or sanctions against the provider.
HIPAA Is Not a Reason to Delay
Some providers hesitate to report because they worry about sharing health information with the county board. Federal regulations at 45 C.F.R. 164.512(b)(1)(ii) specifically permit covered entities to disclose protected health information when reporting abuse, neglect, or other incidents to authorized government authorities.6U.S. Department of Health and Human Services. Does the HIPAA Privacy Rule Preempt State Law to Report Child Abuse Ohio’s mandatory reporting law fits that exception, so HIPAA does not preempt or conflict with the state requirement. Disclose what the county board needs to process the report and nothing more; the exception covers the report itself, not the individual’s full medical history.
What Happens If You Do Not Report
Failure to report is itself a Category A MUI, so the person who stayed silent can become the subject of their own investigation. At the state level, DODD can issue citations during provider audits, require corrective action plans, and impose administrative sanctions. Staff who failed to report can lose the ability to work in the developmental disabilities field in Ohio.
Federal exposure is also real. Knowingly falsifying information in connection with a health care matter violates 18 U.S.C. § 1035. If falsified records lead to improper Medicaid payments, the False Claims Act and 18 U.S.C. § 1347 can apply, with penalties up to ten years in prison, or up to twenty years if the individual suffered serious bodily injury. Providers can also be excluded from Medicaid through the HHS Office of Inspector General, which for most Ohio developmental disabilities providers would effectively end operations.7Office of Inspector General, U.S. Department of Health and Human Services. Exclusions
If Your Employer Retaliates
Protection and Advocacy agencies, authorized under 42 U.S.C. § 15043, have legal authority to investigate suspected abuse or neglect and to access records and facilities to monitor the treatment and safety of individuals with developmental disabilities.8Administration for Community Living. Protection and Advocacy Systems In Ohio, the designated P&A agency is Disability Rights Ohio. If your employer retaliates against you for filing an MUI report, that retaliation can itself become the subject of investigation and enforcement action. Keep copies of the report and your notification log, document any adverse action, and contact Disability Rights Ohio.