Incident Report

Phone: 1300413274

info@safehand.com.au

Detail of Person Reporting the incident

Name(Required)

Role(Required)

Incident Details

Name of Person Involved(Required)

Date of Incident(Required)

Time of Incident(Required)

Incident Number(Required)

What Was Client Doing One Hour Prior to Incident(Required)

How Did Incident Start(Required)

What Happened during The Incident(Required)

How Did Incident Stop(Required)

Was Emergency Services Called(Required)

Yes

Type of Emergency Services Called(Required)

In Case of Police Involvement Attach Business Card of Officer and Provide

Event Number(Required)

Officer Name(Required)

File(Required)

Max. file size: 2 MB.

In Case of Ambulance Involvement

Was Participant Taken to Hospital(Required)

Yes

Reason Participant Was/Wasn`t Taken to Hospital(Required)

Details of Hospital Participant was Take To(Required)

Was Incident Reported to Manager/On Call(Required)

Yes

If No Why Wasn`t The Incident Reported to Manager(Required)

If Yes How and When Was Incident Reported to Management by Support Worker(Required)

(to be completed by house manager within 48 hours of recieving the incident report)

Assessment of the incident including follow up action or any changes made from the incident and Outcomes of the incident for staff to follow

Date

Time

Name