Form 8618, State Long-Term Care Ombudsman Program Initial Certification Training Log

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Effective Date: 5/2024


Updated: 5/2024


Ombudsmen who are in training must document in-person, self-study, and in-facility training hours on HHS Form 8618.


Follow the instructions below to complete the form accurately.

General Information

Name of Person – Enter your first and last name.

Program Name – Enter the name of the office where you will work or volunteer.

Training Requirements 

For certification, the trainee must receive a minimum of 36 hours of initial certification training. The following is required:

  • 16 or more manual training hours must be provided in-person*
  • 10 or more in-facility training hours, which includes time the trainee makes accompanied and unaccompanied visits.
  • At least three additional hours of in-person manual review or in-facility training, or a combination of the two.
  • Seven hours of self-study credit count toward the first 36 hours of training.  All self-study hours are included in the total training hours.

* In-person training means live instruction that may occur in a physical or virtual classroom setting. This includes live in-person meetings, video conferencing applications and phone calls.

Certification Training Manual

Chapter Number and Title

Document in-person and self-study manual review hours separately in the respective columns.

For video or computer-based training (CBT) review, record the exact time specified after each video or CBT title.

Chapter Review – For chapter review, enter the date completed, and the time spent in Hours and Minutes for each chapter.  

In-Person – For chapters reviewed that contain videos or CBTs watched during class, enter the date for each video or CBT. Time spent watching videos or CBTs is included in the chapter’s In-Person Hours and Minutes.

Self-Study – For chapters, videos or CBTs reviewed independently, enter the date and time spent in the applicable boxes under the Self-Study heading.

Example 1 – You spent one hour and 30 minutes on a chapter, enter 1 in the Hours column and 30 in the Minutes column.

Example 2 – You spent 20 minutes on a chapter, enter 0 in the Hours column and 20 in the Minutes column. 

Example 3 – You attend a two-hour in-person class on May 1, 2024. The instructor reviewed the Introduction for 30 minutes, including playing the required three-minute YouTube video. The instructor then reviewed Chapter 1 for one hour and 30 minutes.

Locate the line for the Introduction. In the In-Person column, enter 5/1/24 for the date, 0 hours and 30 minutes. Enter 5/1/24 in the Date column for the video.

Locate the line for Chapter 1. In the In-Person column, enter 5/1/24 for the date, 1 hour and 30 minutes.

In this example, no self-study time is entered for the Introduction or Chapter 1 review.

Example 4 – You watch the Chapter 3 YouTube Video titled The Power of Empathy independently. This video runs for three minutes.

Locate the line for the Chapter 3 empathy video. In the Self-Study column, enter the date and 3 in the Minutes box.

In-Facility Training

Accompanied Training Visits – Enter the date, hours, minutes, the name of the certified ombudsman who accompanies you on the visit, and the facility name.

Unaccompanied Training Visits – Enter the date, hours, minutes, and facility name for each visit.

Other Training Visits – Check either accompanied or unaccompanied, enter the date, hours, minutes, and facility name for each visit. If accompanied, enter the name of the accompanying certified ombudsman.

Subtotals and Grand Total

Subtotals of Certification Training Manual and In-Facility Training – Form 8618 subtotals time for Certification Training Manual and In-Facility Training. Subtotals are displayed in total hours and minutes. Minutes do not roll over into hours.

Grand Total Manual and Facility Training – Form 8618 Grand Totals are displayed in minutes.

Grand Total of Training – Form 8618 converts total minutes and displays in hours.

Staff Ombudsman – To enter Time Spent in the Ombudsman database, convert the grand total to hours and minutes. For example, if the grand total is 48.65, multiply .65 by 60, which equals 39 minutes. Time spent is entered as 48 hours and 39 minutes. Round minutes to the nearest whole number.

Certification of Training Received

Trainee – Type or sign your name and enter the date in the space provided to certify that your training dates and times are accurate.

The Managing Local Ombudsman (MLO) or State Ombudsman (SO) – After reviewing the form and certifying its accuracy, the MLO or SO type or sign their name and date the form.