New Incident Reporting Template (Corrected Link)

Developmental Disabilities Administration Update

June 11, 2019

Dear DDA Service Provider,

DSHS' Developmental Disabilities Administration (DDA) policies require that service providers send an incident report to DDA for certain types of incidents. The DDA Case Manager is required to document information based on each incident report submitted.

We developed a new DSHS form that you can use for reporting incidents to DDA. The form is designed to capture necessary information and prompt you to think of potential steps you might need to take as a result of the incident. The use of this form is encouraged, but not mandatory.

Note - The form is available in a PDF version that can be printed or a Word version that can be used electronically. On the Electronic DSHS Forms site, enter form #20-330.


  • DDA Policy 6.08, Incident Management and Reporting Requirements for County and County Contracted Providers 
  • DDA Policy 6.12, Incident Management and Reporting Requirements for Residential Services Providers 

Contact us for questions or feedback.