For agency purposes there are three levels of MUI’s
The first level are MUI’s that need to be reported to ODMH and/or ODADAS. These would include any event that occurs on agency premises or directly involves any staff member of the agency.
The second level are MUI’s that need to be reported to the ADAMH Board of client’s county of residence. This would include any event that occurs on agency premises or directly involves any staff of the agency. This includes any events that result in law enforcement or emergency medical staff being called to the scene.
The third level are MUI’s that occur that do not fall into the above categories but present an opportunity for education or to prevent an event from happening again.
If you are questioning whether a situation is an MUI, report it, and a determination will be made by the clinical administrative supervisor and the Administrative Coordinator who, if anyone, should receive the report.
Guidelines for Completing Forms
The Major Unusual Incident Report should always be completed with any MUI or abuse and/or neglect issue.
The second form completed depends on the type of MUI, if it is an MUI event only, then the MUI Narrative Form should be completed. If it is an MUI involving abuse and neglect, then the Allegations of Child Abuse Forms should be completed.
If the allegations of abuse and/or neglect are related to an agency staff member, then all three forms should be completed.
All forms are completed entirely, reviewed and signed by a clinical supervisor. Once the forms are signed the are sent to (scanned/faxed/hand delivered) to the Operations Director (or the designated coverage employee). The original forms is filed in the chart.
- (ODMH Directions for MUI Form) (Use of Force Decision Tree)
- ODMH Major Unusual Incident (Handwritten Form)
- ODMH Major Unusual Incident (Fill-in Form)
- ODADAS Major Unusual Incident (Handwritten Form)
Fill out as appropriate:
- Allegations of Child Abuse Form
- Allegations of Adult Abuse Form
- MUI Narrative Form (Handwritten Form)
- MUI Narrative Form (Fill-in Form)
- Bomb Threat Information Form
Communicable Disease Reporting Instructions
If you become aware of someone with one of the reportable communicable diseases listed here: List of Disease you are required to report it.
Different classifications have different timelines as to when you must report by.
- Class A disease – immediately by phone
- Class B disease – by the end of the next business day
- Class C disease – by the end of the next business day
When you become aware of a communicable disease fill out the form found here: Ohio Reportable Disease Form
Please refer to the Infectious Disease Control Manual for proper procedure for notifying your local health department.
After you have reported to the Health Department, Scan the form to Jen Roby for QA records and the original goes in the chart.