LIC 855 - Declaration

Form LIC 855 is a declaration form used in licensed facilities in California. The form is completed by individuals involved in incidents, complaints, or investigations and provides a sworn statement or declaration regarding their knowledge, observations, or experiences related to the matter under review. It includes details such as the individual's name, contact information, and a narrative account of the circumstances. By utilizing this form, licensed facilities gather firsthand accounts or statements that contribute to investigations, decision-making processes, and compliance with regulatory requirements.