What type of incidents go into UI Logs?

Each month, providers are required to complete and retain UI Logs of all Unusual incidents as defined in OAC 5123-17-02(M). These logs contain incidents such as:

• Dental injuries
• Falls
• An injury that is not a significant injury
• Medication errors without a likely risk to health and welfare
• Overnight relocation of an individual due to a fire, natural disaster, or mechanical failure
• An incident involving two individuals served that is not a peer-to-peer act major unusual incident
• Rights code violations or unapproved behavioral supports without a likely risk to health and welfare
• Emergency room or urgent care treatment center visits; and
• Program implementation incidents

Beyond the type of incident included, supporting information is critical to ensure health and safety as well. These facts are crucial to understand what happened, why it happened and how it might be presented in the future. Many times, the more relevant information you can provide about an incident, the better the result. Required information for UI Logs includes, but is not limited to, the following:

1. About the incident:
   1. The name of the individual,
   2. a brief description of the unusual incident,
   3. any injuries,
   4. time, date,
   5. location,
   6. cause and contributing factors, and
   7. preventive measures.
2. About the provider:
   1. The form should also identify the name of the provider,
   2. the month and year being logged, and
   3. the name of the staff that reviewed/completed the log monthly

UI Log Requests

Summit DD will request at least one month’s UI Log from every provider in the county annually, but we may also make additional requests as needed. UI Logs only need sent to Summit DD for review upon request.

• If you are asked to send in a UI Log, please send only the UI Log for the specific month being requested.
• Summit DD may also request supplemental UI investigative materials to assist in our review of these UI Logs.
• If Summit DD requests a UI Log for a period that you as a provider did not have any UIs, a log still needs submitted to Summit DD. Ensure the template has all the required fields and information that can be provided, and just note on the form that you did not have any UIs for that month. (Need a template? Visit our Provider site for templates and sample documentation.)

All requested UI Logs can be sent to

UI****@Su******.org











or faxed to 330-634-8553. If you have questions about the UI Log process, you can either call IA Analyst, Matt Klink at 330-634-8955 or email

UI****@Su******.org