Pennsylvania’s DHS reportable incident form is filed one of two ways: providers in the developmental programs system submit electronically through the Enterprise Incident Management (EIM) system at hhsapps.dhs.pa.gov/EIM, and providers outside EIM — primarily personal care homes and assisted living residences — use the Bureau of Human Services Licensing paper form available as a fillable PDF on the DHS website. Either way, the first report is due within 24 hours of discovery, and a final report closing out the incident is typically due within 30 days.
Which form, which deadline, and which list of reportable events all depend on the chapter of 55 Pa. Code that governs your program. Start there.
Find the Chapter That Governs Your Program
Pennsylvania does not use a single universal incident reporting regulation. Each program type has its own chapter, and the differences are significant enough that filing under the wrong one is a common reason DHS flags a report as incomplete.
- 55 Pa. Code § 6400.18 covers community homes for individuals with intellectual disabilities or autism.1Legal Information Institute. 55 Pa. Code 6400.18 – Incident Report and Investigation
- 55 Pa. Code § 6000.961 is the standardized incident report regulation for Office of Developmental Programs services, requiring submission through the HCSIS/EIM system.2Legal Information Institute. 55 Pa. Code 6000.961 – Standardized Incident Report
- 55 Pa. Code § 2600.16 covers personal care homes and assisted living residences, with the longest list of reportable incidents and conditions.3Legal Information Institute. 55 Pa. Code 2600.16 – Reportable Incidents and Conditions
- 55 Pa. Code § 3270.20 covers child care centers, which follow a separate telephone-plus-written-report process.4Pennsylvania Code. 55 Pa. Code 3270.20 – Reporting Injury, Death or Fire
Confirm your chapter before touching a form. The list of reportable events, the submission method, and the deadlines all differ.
Deadlines by Program Type
Timing is the compliance failure that a 2020 federal audit specifically called out Pennsylvania providers for, so it is worth being precise.5U.S. Department of Health and Human Services Office of Inspector General. Pennsylvania Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities
- Community homes (§ 6400.18): 24 hours for most incidents, including death, suicide attempt, hospital admission, abuse, neglect, exploitation, a missing individual, law enforcement activity, injury beyond first aid, fire requiring fire department response, emergency closure, theft or misuse of individual funds, and rights violations. Restraint use and medication errors on a practitioner-ordered medication carry a 72-hour window. Final report within 30 days.1Legal Information Institute. 55 Pa. Code 6400.18 – Incident Report and Investigation
- Personal care homes and assisted living (§ 2600.16): 24 hours for all reportable incidents and conditions, reported to the DHS personal care home regional office or the complaint hotline. Final report due immediately following conclusion of the investigation.3Legal Information Institute. 55 Pa. Code 2600.16 – Reportable Incidents and Conditions
- Child care centers (§ 3270.20): Telephone notice to the appropriate DHS regional office within 24 hours of an inpatient hospitalization, ER treatment, death, or facility fire requiring a fire department. Written report mailed or delivered within 72 hours. Parents must also be notified immediately.4Pennsylvania Code. 55 Pa. Code 3270.20 – Reporting Injury, Death or Fire
- ODP standardized reports (§ 6000.961): First section within 24 hours; final section within 30 days. Extensions are available only if requested through the system before the deadline expires, not after.2Legal Information Institute. 55 Pa. Code 6000.961 – Standardized Incident Report
The 24-hour clock starts when any staff person discovers the incident, not when management is notified. That distinction matters, and § 6400.18 also requires the investigation itself to begin within that same 24-hour window.1Legal Information Institute. 55 Pa. Code 6400.18 – Incident Report and Investigation
Filing Through the EIM System
Providers in the developmental programs system submit at hhsapps.dhs.pa.gov/EIM. The process runs in two stages under § 6000.961.
The first section captures individual and provider demographics, incident categorization, actions taken to protect health and safety, and a narrative description. Submit it through the system within 24 hours of discovery.2Legal Information Institute. 55 Pa. Code 6000.961 – Standardized Incident Report
The final section keeps everything from the first section and adds information gathered during the investigation, including the certified investigator’s findings. It is due within 30 days of discovery. If your agency cannot meet that deadline, notify both the county and the regional Office of Developmental Programs through the system before the 30 days run out.2Legal Information Institute. 55 Pa. Code 6000.961 – Standardized Incident Report
When multiple individuals at the same provider are involved in certain incident categories, a single site report can replace individual reports for each person. Only incidents specifically designated for site reporting on the Department’s list qualify.
Completing the Paper BHSL Incident Reporting Form
The Bureau of Human Services Licensing Incident Reporting Form is the standard paper-based form for programs outside the EIM electronic system, including personal care homes and assisted living residences. A fillable PDF sits on the DHS website. State investigators will compare what you write against your facility records, so gather your information before you start.6Pennsylvania Department of Human Services. Bureau of Human Services Licensing Incident Reporting Form
Facility and Resident Information
The top section asks for your facility’s legal entity name, the licensed setting name exactly as it appears on your license, the facility address, license number, and phone number. Enter these precisely as they appear on your certificate of compliance. Below that, fill in the resident’s last name, first name, and date of birth for any incident involving a specific individual.
Persons Involved
List every person connected to the incident: staff members, responding officers, witnesses, other residents. For each person, include last name, first name, date of birth, and job title if they are an employee. Record these details within the first few hours. Memories fade and shifts change.
Description of Incident and Follow-Up Action
The narrative section is where most problems occur. Provide as much detail as possible about what happened, where it happened, when it happened, and how the facility responded. Write in plain, factual language: what you observed or were told, not what you think caused it or who you believe is at fault. Speculation here can complicate an investigation and create legal exposure.
The follow-up action field asks what steps have been initiated or planned, including any contacts made to outside agencies. If you called 911, contacted local police, or referred to protective services, document each with dates and times.6Pennsylvania Department of Human Services. Bureau of Human Services Licensing Incident Reporting Form
Abuse Reports Run on a Separate Track
Filing a DHS incident report does not replace your obligation to report suspected abuse through the appropriate channel. If the incident involves a child, call ChildLine at 1-800-932-0313.7Pennsylvania Department of Human Services. Report Child Abuse For adults in personal care homes, § 2600.16 requires that abuse reporting also follow the additional guidelines in § 2600.15, meaning a separate referral to the appropriate protective services agency on top of the incident form.3Legal Information Institute. 55 Pa. Code 2600.16 – Reportable Incidents and Conditions
The two reports serve different purposes. One feeds the Department’s incident tracking system. The other triggers an independent protective investigation. Treating them as interchangeable can delay the abuse investigation and produce a compliance finding against the provider.
What Happens After You Submit
The provider conducts an internal investigation. For community homes, § 6400.18 requires that investigation to begin within 24 hours of discovery.1Legal Information Institute. 55 Pa. Code 6400.18 – Incident Report and Investigation Under § 6000.961, a certified investigator handles the investigation, completes the investigation records, and enters a summary of findings into the system as part of the final section of the incident report.2Legal Information Institute. 55 Pa. Code 6000.961 – Standardized Incident Report
Each facility’s risk management plan must assign responsibility for reviewing, investigating, and analyzing incident reports and reviewing aggregate data to identify trends. For deaths by suicide, homicide, and sentinel events, DHS requires a root cause analysis.8Pennsylvania Department of Human Services. Management of Incidents
State investigators may review submissions independently and conduct follow-up inquiries or on-site inspections to verify what you wrote. The regulations do not set a fixed dollar fine for a missed or late report, but DHS can issue citations during licensing inspections, require corrective action plans, place a facility on provisional license status, or revoke a license in serious or repeated cases. Late or incomplete reports also signal to investigators that a closer look at overall operations is warranted, and the 2020 OIG audit found Pennsylvania had not ensured providers reported thousands of 24-hour reportable incidents on time, prompting recommendations that the state tighten oversight and provider training.5U.S. Department of Health and Human Services Office of Inspector General. Pennsylvania Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities