Open Care Connect - Incident Report

Incident Report

Controlled document workflow

To be completed by witnesses or people involved in the incident.
The source form says within 12 hours of the incident/accident occurring.
Serious incidents must be reported to the NDIS Commission within 24 hours of becoming aware.

Incident Report

INC-RPT-001 | V1.1 | Custodian: Quality & Compliance Manager / All Staff

Use this report for participant, staff member, or other incidents. Record what happened, who provided the information, the effect on the person, the immediate response, and the escalation pathway.

Complete within the timeframe required by the source form. If the incident is serious or reportable, escalation and Commission notification requirements apply.

A - Incident Details

Person involved

Participant Staff member Other

If participant, add valid NDIS number

If other, state whom

Date of incident

Time of incident

Injured person's name

Incident location

B - Person Reporting The Incident

Name of person reporting the incident

Phone

Date of report

C - Witness Details

Name of witness

Phone

Witness description of the incident

D - Incident Narrative

Description of the incident (participant / staff)

Identify who provided information for future investigation

Description of injuries or impact on person (if applicable)

Actions taken by our organisation (e.g. first aid, ambulance called, support to person)

E - Office Use Only

Report received by

Date

Action required

Investigation Continuous improvement review

Reportable incident

Yes No

Date advised

NDIS Commission advised

No Yes

Date Commission advised

Report type

5 day report 24-hour report

Report escalated to

Date report escalated

Other information