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Click ‘Get Form’ to open the NIMS National Incident Report Form in the editor.
Begin with SECTION A: GENERAL INCIDENT DETAILS. Fill in the date and time of the incident using a 24-hour clock format, and specify the location, such as a hospital or health center.
Proceed to SECTION B: PERSON AFFECTED DETAILS. Enter the first name, surname, date of birth, and gender of the affected individual. Indicate if they were offsite.
In SECTION C and D, provide specific details based on whether the person affected is a service user or staff member. Include relevant healthcare record numbers and clinician details.
Complete SECTION F: WHAT WAS THE OUTCOME AT THE TIME OF THE INCIDENT? Select from options like 'Near Miss' or 'No Injury' and detail any body parts affected.
Finally, fill out any additional sections as required, ensuring all fields are completed accurately for effective reporting.

Start filling out your NIMS National Incident Report Form online for free today!

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (94 Votes)
2017	4.2 Satisfied (79 Votes)

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