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HHS CRITICAL INCIDENT FORM Page |1 USE OF FORM within 24 hours of becoming aware of the critical incident: The CI must be documented on DHH SCI Form. CI form (page 1 & 2) shall be completed and emailed
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How to fill out critical incident reporting form

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How to fill out critical incident reporting form

01
Start by gathering all the necessary details and information related to the critical incident.
02
Begin filling out the form by providing the date and time of the incident.
03
Clearly describe the nature of the incident and what took place.
04
Include any relevant witness statements or testimonies.
05
Provide information about any injuries or damages caused by the incident.
06
Indicate any immediate actions taken to address the incident.
07
If applicable, mention any follow-up actions or investigations that were initiated.
08
Double-check the form for completeness and accuracy before submitting it.
09
Sign and date the completed form, ensuring all required sections are filled.
10
Submit the form to the appropriate authority or department responsible for handling critical incidents.

Who needs critical incident reporting form?

01
Anyone who has witnessed or experienced a critical incident needs to fill out a critical incident reporting form.
02
This includes but is not limited to employees, managers, supervisors, customers, and any other individuals who are directly or indirectly involved in the incident.
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The critical incident reporting form is a document used to report any significant events or incidents that occur within an organization.
Certain individuals within an organization, such as supervisors or designated personnel, are typically required to file the critical incident reporting form.
The critical incident reporting form can usually be filled out by providing details of the incident, including date, time, location, individuals involved, and a description of what happened.
The purpose of the critical incident reporting form is to document and track any significant incidents that occur within an organization for future reference and analysis.
Information required on the critical incident reporting form may include details of the incident, individuals involved, any injuries or damages, and actions taken in response to the incident.
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