Alaska Adult Protective Services takes reports of harm to vulnerable adults through this 4-page fillable form, an online intake system or by phone. Harm covers abandonment, abuse, exploitation, undue influence, neglect and self-neglect. The form asks what happened, what was done and how the person will be helped, the suspected cause, what could prevent a repeat, and whether there is risk to the investigator.
The reporter completes the whole form: reporter details with a mandated reporter field, incident information, the alleged victim or involved person, the alleged perpetrator and any collateral contacts.
Download the current version from the source each time; forms change without notice.
Centralized Reporting/Report of Harm Form
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Alaska APS says mandated reporters are required by law to submit a report within 24 hours of learning about harm, and failing to do so could bring legal consequences. Reports can be made online, by phone through Centralized Reporting, or by faxing or emailing this Report of Harm form.
APS lists abandonment, abuse (physical or sexual, or intentionally causing fear), exploitation of the person or their belongings, undue influence by someone in a trusted role, neglect by a caregiver, and self-neglect that causes or could cause a lack of essential services for minimal health and safety.