Incident Report

Incident Report

To be completed within 12 hours of the incident/accident occurring by witnesses or people involved in incident.
Incident Category*

Category 1Category 2Category 3
Category 1 ↓
Used to describe the most severe incidents and describe events which include:

• Death.
• Risk of death.
• Allegations of abuse (physical, sexual, financial, psychological, emotional), neglect or exploitation.
• Risk of abuse (physical, sexual, financial, psychological, emotional), neglect or exploitation.
• Abandonment.
• Risk of abandonment.
• Serious harm or injury due to omission of duty of care.
• Risk of serious harm or injury.
• Alleged criminal activity, inappropriate sexual behaviour of a person we support, property damages resulting in closure of a service for emergency situations.
• Serious complaint.
• Negative media attention for Caura.
• Actions or outcomes of actions that lead to the person we support entering the criminal justice system where a client will not be released from custody to await court proceedings.
• Absconding in contravention to a court order or is likely to result in danger or risk to the person we support.
Category 2 ↓
Refers to a serious but less severe incident than in Category 1.
This type of incident could describe events involving injury or illness to a person where workers compensation could be payable. These incidents include but are not limited to:

• Serious medication error that creates risk for a person we support.
• Attendance by an ambulance.
• Major damage to building or other property.
• Sexual harassment of a staff member while at work.
• A person we support who is missing and where there is potential for high-risk behaviour.
• Actions and or outcomes of actions that lead to the person we support entering the criminal justice system where a client will be released from custody to await court proceedings.
• Harming of Animals.
• Minor injury that does not require hospitalisation.
Category 3 ↓
Refers to incidents which have a less serious or even a minor impact and could include but are not limited to:

• Medication errors including refusal of medication by person we support.
• Exposure to bodily fluids or spills of hazardous substance.
• Injury requiring minor treatment only (e.g. first aid treatment).
• Verbal or attempted physical abuse of a support worker.
• Seizure activity of a person we support.
• Exceedingly inappropriate behaviour (that may or may not lead to arrest).
• Near miss
Event Type

Participant EventStaff InjuryReportable IncidentOthers
Please Specify
What happened before the event?
What happened immediately after?
Details of the event

Witness Details
Name of witness

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Witness' description of the incident

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)
Has this been reported to the staff member's line manager and the participant's guardian? If yes - please provide the time and date of the report.

YesNo
Date reported to the line manager

DayMonthYear
Date reported to the guardian

DayMonthYear
Should be Empty:

Incident Report

Incident Details

Witness Details

Description of the Incident (participant/staff)