Incident Description (Site Level)

The Incident Description (Site Level) screen allows users to capture the details of site level incidents, including a description of the incident, incident location, date(s), time(s), people involved, and other details.

 

Note: Mandatory fields are marked with an asterisk. In addition, some fields are conditionally mandatory, or in other words, become mandatory based on the response to a previous field. All mandatory fields (including conditionally mandatory fields) must be completed on a screen.

 

Field Name

Field Description

Please list all individuals involved

Enter all individuals who were involved in the site level incident.

Please describe in detail exactly what happened during the incident, including dates, times, and all people involved including staff. Include all relevant details prior to, during, and after the incident. Indicate the current status of the individual

Enter detailed information about the incident including dates, times, and people involved (including staff). Include all relevant details prior to, during, and after the incident. Indicate the current status of the individual.
Was the site closed due to fire? Select 'Yes' or 'No' from the drop-down list to indicate if the site closed due to fire. Note: This question should only be answered if the incident is classified as Fire.

Is incident location known?

Select 'Yes' or 'No' from the drop-down list to indicate if the location of the incident is known.

Relationship of the incident location to the site

Select from the drop-down list how the location of the incident relates to the site (i.e. Community Activity, Day Habilitation, Individual's Home, etc.).

In what physical location did the incident occur?

Select from the drop-down list the physical location (i.e. Bathroom, Community, Vehicle, etc.) in which the incident occurred.

If other, please specify:

If 'Other' was specified for the physical location above, please specify the physical location in which the incident occurred.

Location Name (If any):

Enter the name of the location, if applicable.

Address Line 1:

Enter the street address of the location.

Address Line 2:

Enter the second line of the location's address, if needed.

Address Line 3:

Enter the third line of the location's address, if needed.

City:

Enter the city corresponding to the above address.

State:

Select the state corresponding to the above address.

Zip Code:

Enter the zip code corresponding to the above address.