Kentucky Critical Incidents Form

State:
Multi-State
Control #:
US-AHI-093
Format:
Word; 
Rich Text
Instant download

Description

This AHI form is used to record critical incidents. The form includes the incident, employees actions, and the results of these actions.

How to fill out Critical Incidents Form?

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FAQ

What Does an Incident Report Need to Include?Type of incident (injury, near miss, property damage, or theft)Address.Date of incident.Time of incident.Name of affected individual.A narrative description of the incident, including the sequence of events and results of the incident.Injuries, if any.More items...?

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.More items...?

The definition of an incident is something that happens, possibly as a result of something else. An example of incident is seeing a butterfly while taking a walk. An example of incident is someone going to jail after being arrested for shoplifting.

Some of the most common examples of critical incidents that we can help with include:Officer-Involved Shootings.Taser and Non-Lethal Weapon Use.Wrongful Death While in Custody.Official Misconduct Allegations.Sexual Assault Claims.Dereliction of Duty.Volatile Interactions with the Community.

Provide the basic facts. Your form may have blanks for you to fill out with information about the incident. If not, start the report with a sentence clearly stating the following basic information: The time, date and location of the incident (be specific; write the exact street address, etc.). Your name and ID number.

What Is a Critical Incident? Some examples of critical incidents include assaults on employees, hostage-takings, the suicide or murder of a co- worker, accidents causing bodily harm or death, as well as airplane crashes or natural disasters including floods, fires and tornadoes.

Step 1: Provide Fundamental InformationWhat type of injury was caused, if any? Was it fatal or non-fatal?Was there any property damage?When and where did it take place?What task was being done at the time when the incident occurred?What was the environment like?

General Definition A Critical Incident is any actual or alleged event or situation that creates a significant risk of substantial or serious harm to the physical or mental health, safety or well being of a waiver participant.

Keep in mind that these 3 considerations are not to be confused with the 3 requirements for writing an incident report:The report must be factual and without assumption.An incident report must be accurate and without bias.The incident report must be complete.

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Kentucky Critical Incidents Form