Statement Acknowledging Requirement to Report Suspected Abuse

Form Template

Elderly Americans are protected by both federal and state laws against elder abuse, neglect and exploitation.

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But unfortunately, elder abuse still happens. If you are an employer, volunteer or medical provider in a state licensed facility you are considered a mandated reporter and must report any suspected elder abuse. It is the law, and the Statement Acknowledging Requirement to Report Suspected Abuse Mobile App will ensure you understand your requirements and rights.

Care custodians and any person who give full or part-time care or custody to an elder or dependent adult in a long-term care facility must comply with the mandatory reporting requirement.


Abuse can be in the form of physical injury, sexual abuse, emotional abuse, or neglect, and can be based on reasonable suspicion. Failure to report abuse of an elder or dependent adult is a misdemeanor that is punishable by jail time, fine or both. Make sure everyone knows their rights.

After gathering the electronic signatures from the employee, the signed statement acknowledging requirement to report suspected abuse will be saved securely to the GoCanvas Cloud. Generate a PDF to email the form to the employee, facility administrator, and other parties as appropriate. Employees will want to refer back to the mandated reporting policy to ensure compliance.

Features
  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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Platforms
  • iPhone
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  • Windows
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Integrations
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