Incident Report

• Timeliness: This report must be completed and submitted before the end of your current shift.

• Fact-Based: Please provide a detailed, objective account of the event. Avoid personal opinions; focus on what was seen, heard, and done.

• Immediate Action: If this incident involves a patient injury or a sentinel event, you must notify the Facility Supervisor and the Onyx Clinical Director immediately via phone before submitting this form.

• Confidentiality: Do not include full social security numbers. Use patient initials only to maintain HIPAA compliance.

• Copy: A summary of this report will be sent to your email on file for your personal records.