Get Critical Incident Form

Filling out the Critical Incident Form is essential for documenting important incidents related to individuals receiving support services. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to complete the Critical Incident Form online.

1. Click the ‘Get Form’ button to access the Critical Incident Form and open it for online completion.
2. Begin by entering the participant identifying information. Include the participant's first name, middle name (if known), last name, address, city, region, date of birth, parish, and state. Additionally, provide the participant's telephone number and Social Security Number (SSN).
3. Fill in the family or legal guardian's name and contact information, including their address and telephone number.
4. Indicate the service type by selecting from the options provided, such as NOW or CC. Specify the participant's marital status and race as applicable.
5. Detail any disabilities the participant has by checking the relevant boxes. Include mental and physical health considerations.
6. Complete the legal status section, stating whether the participant lives alone, with relatives, or in a facility among other options.
7. Describe the incident by documenting the incident categories that apply. Check all relevant boxes, including those for child or adult abuse, major injuries, and law enforcement involvement.
8. Provide the event information, including the location, date, and time of the incident. Also note when the incident was discovered and who was notified.
9. In the critical incident description section, provide a comprehensive account of the incident, detailing information about individuals involved and communications made. Ensure to include any necessary follow-up actions.
10. Once all sections are completed, review the information for accuracy. You can then save changes, download, print, or share the completed form as needed.

Complete your Critical Incident Form online today by following these guided steps.