Patient fall incident report example 2026

1. Click ‘Get Form’ to open the patient fall incident report in the editor.
2. Begin by filling out the Claimant Information section. Enter the name, address, and location of the incident. Include details for both witnesses, such as their names and phone numbers.
3. In the Incident Information section, specify the date and time of the incident. Clearly describe how it occurred and provide witness accounts.
4. Analyze contributing factors in the Analysis section. Document any unsafe conditions or acts that led to the incident.
5. Outline Corrective Actions taken or planned to prevent future incidents.
6. Ensure all signatures are collected from the claimant and witnesses, along with dates for each signature.
7. Complete the Bodily Injury Information section by detailing the cause of injury and any medical treatment provided.

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