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NEW YORK STATE DEPARTMENT OF HEALTH Adult Care Facility/Assisted LivingIncident Report DSS3123 (Revised 05/12, 11/15 )Facility Name:County:Date of Incident:Time:Regulations: 487.7(d)(113)488.7(b)(113) 490.7(d)(111)Resident.

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All incidents, near-misses and injuries should be reported immediately. The incident reporting process will determine the follow-up required, if any. The employee should not have to make a guess as to whether “their issue or incident” is worthy of an incident report. When in doubt, file an incident report.

Some of the most common types of incident reports include: Accident report. Hazard report. Near miss report.

The 4 main incident reports that should be on your list are: Near Miss Reports. Near misses are events where no one was injured, but given a slight change in timing or action, someone could have been. ... Injury and Lost Time Incident Report. ... Exposure Incident Report. ... Sentinel Event Report.

3 Types of Incidents You Must Be Prepared to Deal With Major Incidents. Large-scale incidents may not come up too often, but when they do hit, organizations need to be prepared to deal with them quickly and efficiently. ... Repetitive Incidents. ... Complex Incidents.

Another approach would be to have four types: Accident, Notifiable Accident, Incident and Notifiable Incident.

Facts related to the incident include: The Basics. Identify the specific location, time and date of the incident. ... The Affected. Collect details of those involved and/or affected by the incident. ... The Witnesses. ... The Context. ... The Actions. ... The Environment. ... The Injuries. ... The Treatment.

The simple model shown in Figure 1 attempts to illustrate that the causes of any incident can be grouped into five categories - task, material, environment, personnel, and management.

It should include: the names and positions of the people involved. the names of any witnesses. the exact location and/or address of the incident. the exact time and date of the occurrence. a detailed and clear description of what exactly happened. a description of the injuries.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232