Form LIC 9060. Resident Theft And Loss Record - California

Form LIC 9060 is used in California by licensed facilities or programs to document incidents of resident theft or loss of personal belongings. The main purpose of this form is to create a record of such incidents and gather relevant information for investigation, reporting, and resolution.

The form consists of sections where the facility or program records details about the incident, including the resident's name, date, description of the stolen or lost item(s), circumstances surrounding the incident, and any known witnesses or involved parties. It may also include space for additional notes, investigation findings, and actions taken to address the incident.

Important fields on this form include accurately documenting the incident and providing specific details about the stolen or lost items, gathering witness statements if available, and promptly reporting the incident to appropriate authorities or supervisors. It is crucial to handle these incidents with sensitivity, ensuring the privacy and dignity of the affected resident while taking necessary steps to address their concerns and prevent future occurrences.

Application Example: In an assisted living facility in California, a resident reports the theft of their wallet. The facility staff complete Form LIC 9060 to record the incident, noting the resident's details, the date of the incident, a description of the stolen items, and any potential witnesses. This form helps the facility document the incident, initiate an investigation, and take appropriate measures to support the resident and prevent similar incidents in the future.