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OFFSITE SURVEY PREPARATION WORKSHEET TASK 1 RESIDENTIAL CARE State Form 53722 (908)INDIANA STATE DEPARTMENT OF HEALTHDIVISION OF LONG TERM CAREFacility: ___ Ombudsman Name/Number: ___ Facility Address:

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How to fill out offsite survey preparation worksheet

01

Gather all necessary information related to the offsite survey.

02

Review the offsite survey criteria and guidelines carefully.

03

Fill out each section of the offsite survey preparation worksheet accurately.

04

Double-check the information entered to ensure accuracy.

05

Submit the completed offsite survey preparation worksheet according to the specified deadline.

Who needs offsite survey preparation worksheet?

01

Organizations or individuals who are planning to undergo an offsite survey to assess their performance or compliance.

02

Team members involved in the preparation and coordination of the offsite survey process.

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What is offsite survey preparation worksheet?

Offsite survey preparation worksheet is a document used to gather information and prepare for an offsite survey inspection.

Who is required to file offsite survey preparation worksheet?

Any organization or individual who is scheduled for an offsite survey inspection must file the offsite survey preparation worksheet.

How to fill out offsite survey preparation worksheet?

The offsite survey preparation worksheet should be filled out with accurate and up-to-date information about the facility or activities being inspected.

What is the purpose of offsite survey preparation worksheet?

The purpose of offsite survey preparation worksheet is to assist in the preparation for an offsite survey inspection by providing necessary information and documentation.

What information must be reported on offsite survey preparation worksheet?

The offsite survey preparation worksheet must include information such as contact details, facility location, activities conducted, safety measures in place, and any potential hazards.

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