POCDesk editorial team · Educational checklist · Updated September 16, 2026

Immediate Jeopardy Response Checklist

Organize an urgent facility response while following the State Survey Agency/CMS instructions for the survey. This is not clinical, legal, or survey-agency advice and is not an official CMS form.

Immediate safety and escalation

1. Confirm the survey team's IJ allegation and place immediate resident safety ahead of document production.
2. Stop or control the deficient practice, protect residents who may be exposed, and obtain urgent clinical or emergency help when indicated.
3. Notify the administrator, director of nursing, attending/covering clinician, and other required leaders under the facility's escalation policy.
4. Assess the resident(s) named or affected and identify other residents who could be exposed; document facts, assessments, notifications, and actions.

Submission and follow-through

5. Coordinate the facility's allegation of compliance or other IJ-removal submission with the State Survey Agency/CMS. Use the agency's instructions rather than a generic template.
6. Keep the separate POC workstream open: IJ removal addresses the immediate threat; the POC addresses the underlying deficiency and prevention.
7. Preserve contemporaneous records and verify every date, role, intervention, and claim before submitting anything.

Primary sources

• CMS nursing home enforcement
• CMS Nursing Home Enforcement FAQ
• CMS State Operations Manual Chapter 7
• CMS State Survey Agency contacts

Coverage limitation: verify facility-specific instructions, deadlines, and findings with the State Survey Agency or CMS. This checklist does not replace the official CMS form or agency direction.