Assisted Living Residences Forms
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This page contains forms used by operators of, or applicants for, assisted living residences. Apart from the Serious Incident Report form and the Application for Exemption form, separate forms are used for seniors and mental health/substance use assisted living residences.
These forms are directly related to the registration and operation of assisted living residences through the assisted living registry. Operators of assisted living residences must commit to ensuring the health and safety of the residents.
| Form # | Form Name and Information |
|---|---|
|
1622 |
A serious incident report form must be filled in by residence site managers after a serious incident has occurred. Serious Incidents include: attempted suicide by a resident, unexpected deaths, abuse or neglect, medication errors, fire or flood, missing persons, police calls, and other incidents that the site manager believes are serious and should be reported. |
| 1627 |
The Community Care and Assisted Living Act requires the Assisted Living Registrar to publish, on a public website, the address of all registered assisted living residences. This form is used to request the suppression of the physical address of residence, only if posting that address would present a risk to the health and safety of the residents who live there. |
Seniors' Assisted Living Forms
| Form # | Form Name and Information |
|---|---|
|
1620 |
The Application for Registration form should be submitted together with the Required Documents Checklist form as well as all required information, attachments and fees at least two months before opening a seniors assisted living residence. Note: New Registrants, if posting the physical address of an assisted living residence publicly on a website would present a risk to the health and safety of the residents living at that residence, please submit an Application for Exemption form (HLTH 1627). |
|
1621 |
The Personal Assistance Service is a worksheet that helps operators and applicants assess the extent to which they are offering personal assistance in any of six service areas and whether they are doing so at the prescribed level. This worksheet must be completed and submitted with the Application for Registration form. |
| 1624 |
The Required Documents Checklist must be submitted with the Application for Registration. This checklist will help applicants to submit the appropriate documents needed for registration. |
Mental Health and Substance Use Assisted Living Forms
| Form # | Form Name and Information |
|---|---|
|
1623 |
The Application for Registration form should be submitted together with the Required Documents Checklist, as well as all required information, attachments and fees at least two months before opening a mental health/substance use assisted living residence. Note: New Registrants, if posting the physical address of an assisted living residence publicly on a website would present a risk to the health and safety of the residents living at that residence, please submit an Application for Exemption form (HLTH 1627). |
|
1624 |
The Required Documents Checklist must be submitted with the Application for Registration form This checklist will help applicants to submit the appropriate documents needed for registration. |
|
1625 |
The Prescribed Services worksheet helps operators and applicants assess the extent to which they are offering personal assistance in any of six service areas and whether they are doing so at the prescribed level. The appropriate worksheet must be completed and submitted with the Application for Registration form. |
