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CRITICAL INCIDENT ANALYSIS FORMConsumer Name: Staff Name(s): Site: Provider Organization: Date of Incident: Time: MHC Case Holder: Type of Incident (see back): Factors that Contributed to Incident
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The critical incident analysis form is a document used to report and analyze critical incidents that occur within an organization.
All employees or members of an organization who witness or are involved in a critical incident are required to file the critical incident analysis form.
The critical incident analysis form should be filled out by providing detailed information about the incident, including what happened, when it happened, and any relevant details.
The purpose of the critical incident analysis form is to help organizations learn from critical incidents, identify areas for improvement, and prevent similar incidents from occurring in the future.
The critical incident analysis form must include information such as the date and time of the incident, the location, individuals involved, a description of what happened, and any actions taken in response to the incident.
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