New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 47 - STANDARDS FOR PRIVATE LICENSED FACILITIES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
Subchapter 3 - ADMINISTRATION
Appendix - APPENDIX

Universal Citation: NJ Admin Code

Current through Register Vol. 56, No. 6, March 18, 2024

APPENDIX
DDD CLASSIFICATION OF INCIDENT CATEGORIES
Primary	Reporting
Type Code	Category	DHS Community Incident Category List	Level
AB116	ABUSE	Physical (alleged) -- to Service Recipient --	A+
Major Injury
AB114	ABUSE	Physical (alleged) -- to Service Recipient --	A
Moderate Injury
AB112	ABUSE	Physical (alleged) -- to Service Recipient --	B
Minor Injury
AB110	ABUSE	Physical (alleged) -- to Service Recipient --	B
No Injury (Community only)
AB220	ABUSE	Emotional (DYFS & IA Only) Substantiated	A+
AB210	ABUSE	Emotional (DYFS & IA Only) Risk of	A
AB310	ABUSE	Verbal/Psychological/Mistreatment (alleged)	B
AB420	ABUSE	Sexual (alleged) -- to Service Recipient --	A+
penetration/genital contact, oral sex
AB410	ABUSE	Sexual (alleged) -- to Service Recipient --	A
all other forms of sexual contact or
situations
AS116	ASSAULT	Physical -- SR to SR -- Major Injury	A
AS114	ASSAULT	Physical -- SR to SR -- Moderate Injury	B
AS126	ASSAULT	Physical -- SR to Staff -- Major Injury	A
AS124	ASSAULT	Physical -- SR to Staff -- Moderate Injury	B
AS136	ASSAULT	Physical -- SR to Other -- Major Injury	A
AS134	ASSAULT	Physical -- SR to Other -- Moderate Injury	B
AS316	ASSAULT	Physical -- Other to SR -- Major Injury	A
AS314	ASSAULT	Physical -- Other to SR -- Moderate Injury	B
CR400	CRIMINAL	Suspected or alleged; SR (on or off site)/	A
ACTIVITY	Staff or Other; on site and/or on duty,
considered to be potentially newsworthy and
not in violation of SR confidentiality.
(Community only)
DL010	DANIELLE'S	Medical emergency: life threatening situation	A
LAW	911 called
DL011	DANIELLE'S	Medical emergency: life threatening situation	A
LAW	911 not called. DDD/TBI only
DL020	DANIELLE'S	Other than medical: life threatening	A
LAW	situation. 911 called
DL021	DANIELLE'S	Other than medical: life threatening	A
LAW	situation. 911 not called
DT110	DEATH	Expected: due to medical condition, disability	A
or end stage disease/illness
DT210	DEATH	Unexpected: Sudden [i.e. due to suspected	A+
choking, medical incident (suspected heart
attack)
DT310	DEATH	Unexpected: Suicide	A+
DT320	DEATH	Unexpected: Accidental	A+
DT410	DEATH	Unexpected: Undetermined manner (This code to	A+
be used for follow up/findings only)
EL110	ELOPEMENT	SR with KROL, IST, NGRI, Detainer, Megan's	A+
Law/Sex offender status (Also see Walkaway
category)
EL120	ELOPEMENT	SR from a designated screening center if not	A
returned within 2 hours. (Community only)
EX110	EXPLOITATION	of SR: Improper use of SR by staff.	A
EX130	EXPLOITATION	of SR: Improper use of SR's funds by staff,	A
value is equal to or above $ 500 (Community
only)
EX140	EXPLOITATION	of SR: Improper use of SR's funds by staff,	B
value is below $ 500 or undetermined
(Community only)
IN116	INJURY	Accidental -- Service Recipient -- Major	A
IN114	INJURY	Accidental -- Service Recipient - Moderate	B
IN216	INJURY	Self-injurious behavior -- Major	A
IN214	INJURY	Self-injurious behavior -- Moderate	B
IN226	INJURY	PICA -- ingestion of foreign object after	A
PICA behavior has been identified resulting
in major injury
IN224	INJURY	PICA -- ingestion of foreign object after	B
PICA behavior has been identified resulting
in moderate injury
IN316	INJURY	Unknown origin: SR, Major	A
IN314	INJURY	Unknown origin: SR, Moderate	B
IN426	INJURY	Staff: Work related: (not due to assault) --	A
Major (i.e. broken bones)
IN436	INJURY	Staff, Non-work related [but occurring on	A
campus/site] (not due to assault)-Major
IN516	INJURY	Restraint Related Major injury	A
IN514	INJURY	Restraint Related Moderate injury	B
IN510	INJURY	Restraint Related Minor injury (Community	B
only)
MD110	MEDICAL	Disease/Illness -- Single incident of disease	B
that is reportable to DHSS.
MD120	MEDICAL	Disease/Illness -- Outbreak of a communicable	A
disease that impact on the operation of the
program.
MD220	MEDICAL	Medication/Treatment Error -- Any deviation	A
from prescribed orders that results in serious
effects requiring medical intervention
MD212	MEDICAL	Medication/Treatment Error -- Any deviation	B
from prescribed orders that has the potential
for serious effects as determined by a
qualified medical professional (i.e. --
doctor, pharmacist) (Community only)
NE216	NEGLECT	With major injury	A
NE214	NEGLECT	With moderate injury	B
NE212	NEGLECT	With minor injury	B
NE213	NEGLECT	With No injury (but incident resulted in risk	B
to SR) Examples include but are not limited
to inadequate food, clothing or supervision.
(Community only)
OP310	OPERATIONAL	Environmental incidents -- Spills, illegal	A
dumping
OP430	OPERATIONAL	Fire -- Major event -- resulting in damage	A+
which renders facility or part thereof,
unusable or resulting in any injuries to staff
or service recipients
OP420	OPERATIONAL	Fire -- Moderate event -- requiring outside	A
assistance to extinguish or contain
OP410	OPERATIONAL	Fire -- Minor event -- extinguished or	B
contained using facility staff/Fire personnel
OP590	OPERATIONAL	Media interest: When no other incident	A+
category applies.
OP540	OPERATIONAL	Unexpected Staff Shortages -- Which may pose	A
a threat to life/safety or impact on facility
operations
OP530	OPERATIONAL	Public Safety Issues: Posing immediate threat	A+
to life/safety (i.e. natural disaster, hostage
taking, terroristic threats)
OP520	OPERATIONAL	Mass Disturbances (i.e. riot) involving 5 or	A+
more people (staff or SR)
OP510	OPERATIONAL	Operational breakdown Any utility outage or	A
loss of use of equipment which may cause a
threat to life or safety and impact on
facility operations
OP500	OPERATIONAL	Unannounced/Unexpected site visit for any	B
purpose at a facility/school by any
regulatory/investigatory/inspection unit.
Examples: CMS, DOH, JCAHO, DEP, Public
Advocate, Child Advocate, DOJ, Prosecutor's
Office or similar agency/office.
OP745	OPERATIONAL	Loss: SR(s) funds or property value	B
(individual or aggregate) over $ 200.
(Community only)
OP740	OPERATIONAL	Theft: SR(s) funds or property value	A
(individual or aggregate) over $ 200.
(Community only)
RE111	RESTRAINT	Restraint implemented on a SR without an	B
USE	order or approved behavior plan or in
violation of an approved plan. (Community
only)
RE120	RESTRAINT	Restraint to remove SR from harm. (Community	B
USE	only)
RG210	RIGHTS	Alleged act challenged by legal or advocacy	A
VIOLATION	group
RG110	RIGHTS	Alleged act not challenged	B
VIOLATION
SA200	SEXUAL	Involving SR as Victim or Perp With or	A+
ASSAULT	Without Injury
SX110	SEXUAL	SR to SR (nonconsensual)	B
ASSAULT
SX120	SEXUAL	SR to Staff or Other	B
ASSAULT
SX310	SEXUAL	Other to SR	A
ASSAULT
SX400	SEXUAL	Inappropriate Sexual Conduct (i.e. exposing	B
ASSAULT	one's self to another, public masturbation)
No physical contact with another person but
occurring in a public setting.
SU116	SUICIDE	Resulting in major injury	A+
ATTEMPT
SU114	SUICIDE	Resulting in moderate injury	B
ATTEMPT
SU113	SUICIDE	Resulting in minor injury (Community only)	B
ATTEMPT
WK410	WALKAWAY	SR Dangerous to self or others (violence) but	A+
[No Criminal	no criminal status
Status]
WK320	WALKAWAY	SR at risk due to disability (medical or	A
[No Criminal	cognitive) [i.e. may need medication such
Status]	as insulin] or due to extreme weather or
environmental conditions
WK310	WALKAWAY	SR at risk due to age (18 or younger) or 60+	A
[No Criminal
Status]
EE110	ERROR CODE	Community Incident report entered in error	B
(Community only)

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New Jersey Administrative CodeTitle 10 - HUMAN SERVICESChapter 47 - STANDARDS FOR PRIVATE LICENSED FACILITIES FOR PERSONS WITH DEVELOPMENTAL DISABILITIESSubchapter 3 - ADMINISTRATIONAppendix - APPENDIX

New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 47 - STANDARDS FOR PRIVATE LICENSED FACILITIES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
Subchapter 3 - ADMINISTRATION
Appendix - APPENDIX