Get Unusual Occurrence Report
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Open form follow the instructions
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How to fill out the Unusual Occurrence Report online
Filling out the Unusual Occurrence Report online is a vital process for documenting events that require attention. This guide will provide step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to fill out the Unusual Occurrence Report with ease.
- Press the ‘Get Form’ button to access the report and open it in your preferred online editing tool.
- Enter the client’s name in the designated field to ensure identification is clear.
- Provide the client's address in the specified section to maintain accurate records.
- Fill in the date of the occurrence in the corresponding date field.
- Record the time of the occurrence by selecting either AM or PM.
- Identify the type of occurrence by circling all applicable options from the list provided.
- In the description area, detail the occurrence, providing as much relevant information as possible.
- Specify the location of the occurrence by selecting from the options or describing the location, if ‘Other’ is applicable.
- Indicate whether the client was injured by selecting ‘No’ or ‘Yes’, and provide additional details if applicable.
- Specify whether the client was taken to the hospital and provide the name of the hospital if applicable.
- Document whether the family was notified, including their name, date, and time of notification.
- Fill in the details of the person completing the report, including their title.
- Record the date and time the report is being completed.
- Finally, save your changes, and download, print, or share the completed form as needed.
Complete your Unusual Occurrence Report online today and ensure all incidents are documented properly.
Date, time, and facility location. Where the incident occurred. Incident type. Name of the person(s) affected by the incident. Witnesses or names and titles of other involved persons. Written summary of what happened, which can include:
Fill Unusual Occurrence Report
The unusual occurrence report is a guide to walk through a thorough investigation for a root cause analysis. Any agency or individual may submit an Unusual Occurrence Report. • Unusual Occurrence Reports may be submitted via fax, mail, email, or in person. Any Unusual Occurrence should be documented separate and apart from a Patient Care Report or other business record. CDPH has indicated that the following events should be reported as unusual occurrences: 1.
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