Free Critical Incident Report Form Template
Critical Incident Report Form
Please fill out this form completely to document a critical incident.
Incident Information
Date and Time of Incident
Location
Reporter Information
Name
Position/Role
Phone number
Individuals Involved
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Role |
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Description of Incident
Provide a detailed description of the incident, including what occurred, actions taken, and the outcome
Immediate Action Taken
Describe any immediate steps or actions taken to address the incident
Follow-Up Recommendations
List any suggested follow-up actions or preventative measures
Signature
I confirm that the above information is accurate to the best of my knowledge.
Name:
Date:
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