Get National Incident Report Form

Filling out the National Incident Report Form is crucial for documenting incidents that may have led to unintended harm. This guide provides clear, step-by-step instructions on how to complete the form online, ensuring accuracy and thoroughness in your reporting.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section A, provide general incident details, including the date and time of the incident, as well as the location using the 24-hour clock format.
3. Complete Section B with the details of the person affected by the incident, including their first name, surname, date of birth, and select their gender.
4. In the description of the incident, detail what occurred, ensuring to cover every crucial aspect.
5. Select the division involved in the incident by ticking the appropriate box, and then identify who was involved by selecting from options such as service user, staff member, or member of the public.
6. If the incident involved a service user, fill out Section C with their healthcare record number and the lead clinician's name.
7. For staff member or agency staff details, fill Section D, including the category of person and employee number if applicable.
8. If an external contractor was involved, complete Section E with the company name and company number.
9. In Section F, indicate the outcome of the incident, choosing from options such as near miss, no harm, or injury requiring treatment.
10. Specify the type of injury sustained in Section G by ticking one option that best matches.
11. In Section H, identify what type of hazard the incident related to, selecting from provided steps.
12. Complete Section I with any immediate actions that were taken following the incident.
13. In Section J, indicate whether open disclosure was required and if the incident is classified as a serious reportable event.
14. Fill in the reporter's details in Section K, capturing their first name, surname, and any relevant signatures.
15. Finally, review the entire form for accuracy. Save your changes, download, print, or share the completed form as needed.

Complete your National Incident Report Form online to ensure consistent and thorough documentation of incidents.