Care home incident report template 2026

1. Click ‘Get Form’ to open the care home incident report template in the editor.
2. Begin by entering the Personal Health Number and WCB Claim Number at the top of the form. Ensure these are accurate for proper identification.
3. Fill in the worker’s surname, first name, address, city/town, province, postal code, and telephone number. This information is crucial for contact purposes.
4. Record the date of the accident and the worker's date of birth in the specified format (yyyy/mm/dd).
5. Provide details about the claim owner and provider’s name along with their respective telephone numbers.
6. Indicate when the report was faxed to WCB by filling in both date and time fields.
7. In the 'Description of Incident' section, provide a detailed account including dates and times. This is essential for clarity.
8. Answer whether there have been similar incidents in the past. If yes, describe how they were resolved and what recommendations you have for this incident.
9. Finally, print your name as submitter, include your telephone number, and sign where indicated before submitting.

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