INCIDENT REPORT
This form is to be completed when there is an incident which occurs that is inconsistent with the routine operations and service provided, including but not limited to injury to a resident or staff, property destruction, resident elopement or staff errors that cause harm (or potential harm) to a resident. Any incidents, complaint or circumstances that may cause ill will to the agency or its personnel must also be reported using this form. This form must be FULLY COMPLETED and SUBMITTED before the end of the shift in which the incident occurred. The Lead DSP or Program Director must also be notified verbally before the end of the shift. If 2 residents are affected by the same incident, SEPARATE incident Reports must be submitted.
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  • A reminder that other resident's names must be excluded, in favor of (Person #1, Person #2, etc).
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