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Critical incident reporting form 2026
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- Click ‘Get Form’ to open the critical incident reporting form in the editor.
- Begin by entering the Facility’s License Number, Facility Name, and Telephone Number at the top of the form. This information is essential for identification.
- Fill in the Date of Report and Date of Incident fields accurately to ensure proper tracking of events.
- List all Recipient(s) Involved by providing their full names, along with the Person Reporting and Time of the incident (AM/PM).
- Select the Incident Type by checking all applicable boxes. This section includes serious incidents such as suicide, homicide, or injury requiring medical attention.
- Indicate if there are any attachments related to the incident and provide a summary in the designated area. Ensure that all relevant documents are included for thoroughness.
- Complete the QA Review section by evaluating policies and procedures followed during the incident response. Document any necessary modifications or training plans.
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