Copy of OHAN Investigations Instrument QA Section A: Identifying/Basic Information Question Title * 1. Case Name Question Title * 2. Case ID Question Title * 3. Provider ID Question Title * 4. County of Facility/Foster Parent Abbeville Aiken Allendale Anderson Bamberg Barnwell Beaufort Berkeley Calhoun Charleston Cherokee Chester Chesterfield Clarendon Colleton Darlington Dillon Dorchester Edgefield Fairfield Florence Georgetown Greenville Greenwood Hampton Horry Jasper Kershaw Lancaster Laurens Lee Lexington Marion Marlboro McCormick Newberry Oconee Orangeburg Pickens Richland Saluda Spartanburg Sumter Union Williamsburg York Question Title * 5. County of Origin (Child) (if more than 1 child, list all counties) Child 1 Child 2 Child 3 Child 4 Child 5 Question Title * 6. Reviewer's Name Question Title * 7. Second Level Reviewer's Name Question Title * 8. Investigator's Name Devan Davis Aswad Salaam Tyler Gilbert Jenette Bennett Teresa Brown Desyona Davis Ray Polkey Sheray Jones Melissa Pettinato-Irby Wanda Banker Patricia (Pat) Burgess Brittany David Garland Major Amylynn Emily Breanna Robertson Lynique Johnson Wanda McDonald Other (please specify) Question Title * 9. Supervisor's Name Louise Cooper LaWanda Greggs Tequila Hunter Janie Heyward-Grissett Other (please specify) Question Title * 10. Period Under Review September 2019 March 2020 September 2020 March 2021 September 2021 Question Title * 11. Is this investigation appropriate for this review? Yes No If no, please specify why not and consult with QA team. Next