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Download Incident Report Form Template

An Incident Report Form and its Purpose:

Many health organizations worldwide operate on the precedent that there remains a level of accountability to their daily work. An incident report form is a document that needs to be filled out in order to record details pertaining to a particular incident, an accident or an unusual event that might occur at a scene. It may also include medical and trauma events contracted by a patient.

incedent-report-form-sample

The purpose of the incident form then is to essentially operate as a record of all the emergencies or situations handled by an organization. It assists a medical responder, for example, to record all the details of the events while it is still fresh in mind and so that it can be used for future reference in case someone wants to know more about how a particular situation was handled and how the response could be made more efficient.

Constituents of An Incident Report Form:

Ideally an incident report form contains 5 main sections:

  1. Incident information
  2. Individuals involved
  3. Witnesses information
  4. Property damage/relevant directors’ and officers’ issues
  5. Driver contact information

The opening section notes down the details about what incident occurred at what place and at what time. At the time of the incident, who was the reporting person and what might have been the cause of the incident. Furthermore, if it occurred while traveling/transporting to/from an activity and additional comments about the incident.

Moving on, the second section about individuals involved notes down the personal information details about other team members of the response team. It also emphasizes on the kind of assistance that was provided through these individuals for, again, record keeping and accountability of all the people involved in the incident.

Furthermore, the section on witnesses takes note of bystanders who played an important role at the time of the incident or who might be required in case of future reference with regards to the incident or the accident. For example, in case of a road accident where the patients might be unconscious to narrate the incident or highlight anything for the doctor, the witnesses or the bystanders are then crucial for the hospital officials. They might be able to reflect on the accident such that it might help the doctors in assessing the injuries and damage incurred.

Lastly, the sections on property damage and driver contact information serve as important additions to the incident report form as well. Accounting for all the tangible loss incurred during the incident, keeps a track for the insurance companies who need to assess the claims of the patients later on to determine their credibility. Furthermore, in case there is a direct conflict with any of the members from the host organization, this section can help you in making note of all the relevant details for reference. Driver contact information on the other hand helps in keeping the record for the employers of the medical organization. In case a specific incident briefing is required, the firm can contact the people involved through the form to extract the information.

Therefore, the incident report form tends to keep a note of all the different sort of emergencies that have been handled by a department for their record-keeping and to use for training purposes and for future reference. You may download incident report form template is available in the Doc format.

Sara Smith

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