LIC 9029B - Statement Of Facts Preparation Checklist

Form LIC 9029B is a preparation checklist used in the creation of a statement of facts regarding incidents, complaints, or investigations in licensed facilities in California. The form is completed by authorized personnel involved in the preparation process and provides a structured guide to ensure all relevant information is included in the statement. It covers areas such as incident descriptions, involved parties, dates and times, witness statements, supporting documentation, and any required attachments. By utilizing this form, facilities facilitate comprehensive and accurate reporting, support thorough investigations, and comply with regulatory requirements related to incident documentation.