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3246F AVERSIVE INTERVENTION INCIDENT REPORT Date of Report: Date of Incident: Person Completing Report: Time of Incident: Duration: Date & time of Parent Notification: (parent/guardian) was notified

How to fill out aversive intervention incident report

How to fill out aversive intervention incident report:

Start by obtaining the necessary form:

1. Contact your organization's HR department or supervisor to request the aversive intervention incident report form.
2. Make sure you have the latest version of the form to ensure accuracy.

Gather relevant information:

1. Collect all the necessary details about the incident, such as date, time, and location.
2. Identify the individuals involved, including the staff members and the individuals receiving care.

Describe the incident:

1. Clearly and objectively explain what happened during the aversive intervention.
2. Include details about the behavior that prompted the intervention and the actions taken by the staff.

Document any injuries or harm:

1. If any injuries occur during the aversive intervention, describe them accurately and provide details about the extent of the harm.
2. Include information about medical attention given or required as a result of the incident.

Outline witness statements:

1. If there were any witnesses present during the aversive intervention, record their statements regarding what took place.
2. Include their names and contact information for further reference if needed.

Mention de-escalation attempts:

1. If there were prior attempts to de-escalate the situation before resorting to aversive intervention, describe them briefly.
2. This demonstrates that the intervention was a last resort.

Include supporting documentation:

Attach any relevant documents such as incident reports, training records, or supporting evidence that may help with the investigation or understanding of the incident.

Sign and submit the report:

1. Read through the completed aversive intervention incident report carefully, ensuring all information is accurate and concise.
2. Sign and date the report to signify its completion.
3. Submit the report to the designated authority or department responsible for processing and reviewing such incidents.

Who needs aversive intervention incident report?

1. Aversive intervention incident reports are typically required by organizations or facilities that provide care and support to individuals with behavioral or developmental challenges.
2. These reports are crucial for documenting any incidents involving the use of aversive interventions, such as physical restraints or other behavior management techniques considered more intrusive.
3. Staff members directly involved in the incident, as well as managers, supervisors, and administrative bodies, may need access to these reports for various reasons, including regulatory compliance, staff training, and policy review.

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What is aversive intervention incident report?

Aversive intervention incident report is a document that details any instances where aversive interventions were used on an individual.

Who is required to file aversive intervention incident report?

Aversive intervention incident reports are usually required to be filed by the individuals or organizations that implemented the aversive interventions.

How to fill out aversive intervention incident report?

To fill out an aversive intervention incident report, one must provide details of the incident, including when and how the aversive intervention was used.

What is the purpose of aversive intervention incident report?

The purpose of aversive intervention incident report is to document and track the use of aversive interventions to ensure they are being implemented appropriately and ethically.

What information must be reported on aversive intervention incident report?

Information such as the date and time of the incident, the type of aversive intervention used, the reason for its use, and the outcome of the intervention must be reported on the aversive intervention incident report.