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INCIDENT DETAILS Incident Involved (circle) Client / Patient /Staff / Visitor / Other (detail):Date of Birth:Given Name:Gender:Female MaleFamily Name:Hospital Number (if applicable):DATES Incident
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An incident report form is a document used to record details about an event that has caused or has the potential to cause harm or damage. It is commonly used in various organizations to report accidents, injuries, or other significant incidents.
Typically, any employee or individual who witnesses or is involved in an incident that requires documentation is required to file an incident report form. Specific policies may vary by organization.
To fill out an incident report form, one should provide the date and time of the incident, a description of what occurred, names and roles of those involved, any witnesses, and any actions taken as a result of the incident. It is important to be factual and detailed.
The purpose of an incident report form is to provide a formal record of an incident for analysis, to ensure proper follow-up actions are taken, to identify trends that may require further investigation or prevention measures, and to comply with legal and regulatory requirements.
An incident report form must generally include the date, time, and location of the incident; a detailed description of the incident; names of individuals involved or affected; witness statements; and any actions taken in response to the incident.
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