Click on the MUI Form to view it on-line or print:

 

This form is to be sent from each County Board to SOCOG when a new MUI is filed. This form should be filled out completely by the MUI Contact or designee.

Once the final report is sent to the County Board from SOCOG, this form is to be returned by the County Board MUI Contact or designee to SOCOG by the date stipulated. This form should be checked off and signed accordingly.

When a MR/DD employee is suspicious or knows something is not right, this form (or one developed by the County Board/Provider) should be filled out in detail and sent to the appropriate person of the agency they work with. If it is unknown who to send the report to, please check with the County Board MUI Contact or designee.

The Prevention Plan should address the causes and contributing factors to the incident. The individual’s team should determine what reasonable steps are necessary to prevent the reoccurrence. This form, or similar form, should be completed by the team and sent to SOCOG within the 24th day of the investigation. If there is no SSA, individual team or agency provider involved with the individual, a County Board designee shall ensure that preventative measures as are reasonably possible are fully implemented.

CB MUI Checklist

 

 

17273 St Rt 104, Building 8 Chillicothe, Ohio 45601

Phone Number: 740-775-5030

 

A Council of Governments

Fax Number: 740-775-5023 Hours: M-F, 8:00am - 4:00pm