Nursing Home Surveyor Guide to Calling an Immediate Jeopardy

To clearly and concisely communicate a finding of immediate jeopardy (IJ), survey teams must use the IJ template attached to Appendix Q to determine if IJ exists, and the state agency (SA) must provide the completed IJ template to the entity when IJ is called.

If an IJ is identified through the survey process, surveyors will follow guidelines consistent with the State Operations Manual, Appendix Q -Core Guidelines for Determining Immediate Jeopardy. Surveyors will complete the IJ template which is consistent with Appendix Q. 

The link for Appendix Q and the IJ template: Medicare State Operations Manual

Please refer to the Appendix Q subparts for appropriate, provider-specific instruction.