Free Employee Mental Health Incident Report Template
Employee Mental Health Incident Report
I. Incident Details
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Date of Incident: October 5, 2050
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Time of Incident: 2:30 PM
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Location of Incident: Conference Room B
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Employee(s) Involved: Harold Abern, Marketing Specialist
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Witness(es): Jarrett Bailey, Team Lead; Macey Erdman, HR Manager
II. Description of Incident
On October 5, 2050, at approximately 2:30 PM, Harold Abern, a Marketing Specialist, exhibited signs of extreme distress during a team meeting held in Conference Room B. The meeting was intended to discuss upcoming marketing strategies. Harold appeared visibly anxious and began to withdraw from the discussion, avoiding eye contact and fidgeting with his hands.
As the meeting progressed, Harold abruptly stood up and left the room, expressing feelings of being overwhelmed and stating, "I can’t do this anymore." Witnesses, Jarrett Bailey and Macey Erdman noted that Harold had been displaying signs of stress over the past few weeks due to an increased workload and tight deadlines. They reported that he had previously mentioned feeling unable to manage his responsibilities effectively.
III. Response Actions Taken
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Immediate Actions:
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Jarrett Bailey immediately followed Harold to ensure his well-being and check on his condition.
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Macey Erdman contacted the Employee Assistance Program (EAP) to provide Harold with immediate mental health resources.
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The meeting was adjourned to give team members space to process the incident.
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Support Provided:
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Harold was offered a referral to a licensed counselor through the EAP for mental health support.
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A follow-up conversation was scheduled for the following week to assess his needs and provide additional resources.
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Notifications:
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HR was notified of the incident, and an internal report was filed to document the occurrence and response.
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Harold's direct supervisor was informed to ensure he receives the necessary support and flexibility with his workload.
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IV. Follow-up Actions
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Scheduled Meetings:
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A one-on-one meeting with Harold is scheduled for October 12, 2050, to discuss his experience and provide ongoing support.
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A team meeting will be held on October 15, 2050, to address any concerns from the incident and promote mental health awareness within the team.
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Policy Review:
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HR will conduct a review of the current workplace policies regarding mental health support and incident reporting to identify areas for improvement.
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Additional Support:
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An all-staff workshop on stress management and mental health resources is scheduled for October 20, 2050, to promote a supportive work environment.
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V. Recommendations
To prevent similar incidents in the future, the following actions are recommended:
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Implement regular check-ins with employees to discuss workload and mental health.
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Provide training for managers on recognizing signs of mental distress and appropriate response actions.
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Consider establishing a peer support program where employees can confidentially share their experiences and coping strategies.
Report Completed By
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Name: [Your Name]
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Title: Human Resources Manager
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Date of Report: October 6, 2050