Nursing Home Abuse & Neglect Confidential Reporting Form

Protect vulnerable adults with a secure nursing home abuse reporting system

When abuse or neglect occurs in nursing homes and long-term care facilities, quick and confidential reporting can save lives. This Nursing Home Abuse & Neglect Confidential Reporting Form provides healthcare workers, family members, and concerned citizens with a secure, anonymous way to report suspected mistreatment to the appropriate state agencies.

Built on Paperform's SOC 2 Type II compliant platform, this template ensures sensitive information is handled with the highest security standards. The form includes mandatory reporter guidance, conditional logic that adapts questions based on the type of incident, and smart routing to help reports reach the right authorities quickly.

Who this form is for

This template is designed for nursing homes, assisted living facilities, state health departments, adult protective services agencies, long-term care ombudsman programs, and advocacy organizations that need to receive and process abuse reports efficiently and confidentially.

Mandatory reporters—including nurses, physicians, social workers, and facility staff—can use this form to fulfill their legal reporting obligations, while family members and concerned individuals can submit anonymous tips without fear of retaliation.

How Paperform makes confidential reporting easier

Paperform's conditional logic ensures reporters only see relevant questions based on the type of abuse they're witnessing, making the form faster to complete during stressful situations. You can customize the form to include your state's specific reporting requirements and agency contact information.

Once a report is submitted, use Stepper (stepper.io) to automatically route high-priority cases to the appropriate investigators, send confirmation emails to reporters who choose to identify themselves, log incidents in your case management system, and trigger follow-up workflows. Integration with tools like Google Sheets, Airtable, or your CRM ensures every report is documented and tracked through resolution.

For organizations managing reporting across multiple facilities, Paperform's Agency+ plan makes it easy to deploy customized versions of this form for different locations while maintaining centralized oversight and consistent reporting standards.

Whether you're a state agency building a public reporting portal or a facility implementing an internal safety program, this template provides the foundation for protecting vulnerable adults through accessible, confidential reporting that meets compliance requirements and builds trust with families and staff.