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.

5,000 Companies save time and money with GoCanvas

Lumen Logo Post Consumer Brands Logo Saluda Hill Landscapes Logo Te3co Logo Two Men and a Truck Logo VIP Lighting Logo

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.

  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
Read More
  • iPhone
  • iPad
  • Android
  • Windows
Read More
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
Read More
*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

Connect with one of our experts today.

We’ll help you put together the right solution for your needs.

Contact Us