X reporting form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Facility Information' section. Enter the name, type, and registration number of your facility, along with the address details.
3. In the 'Person Reporting Incident' section, provide your name, title, and contact information including phone number, fax number, and email address.
4. Next, complete the 'Patient / Reporting Information' section. Fill in all relevant dates and times regarding when the incident was reported and when it occurred.
5. Indicate the affected patient or employee's details such as name, age, sex, medical record number (if applicable), date of admission, date of birth, and diagnosis.
6. Select the type of incident by checking appropriate boxes. If necessary, attach a copy of any additional incident reports.
7. Provide a brief description of the circumstances surrounding the incident. Use an additional sheet if needed.
8. Check all categories of staff involved in the incident and detail any immediate corrective actions taken.
9. Finally, complete the acknowledgment section by signing off with your name and title before submitting.

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