Hospital Incident Report Sample
Guardar, completar los espacios en blanco, imprimir, listo!
How to create a Hospital Incident Report Sample? Download this Hospital Incident Report Sample template now!
Formatos de archivo disponibles:
.pdf- Este documento ha sido certificado por un profesionall
- 100% personalizable
Business Negocio report informe clinic clínica employee empleado Incident Incidente Call Llamada Free Incident Report Informe de incidencias gratuito
How to draft a Hospital Incident Report Sample? An easy way to start completing your document is to download this Hospital Incident Report Sample template now!
Every day brings new projects, emails, documents, and task lists, and often it is not that different from the work you have done before. Many of our day-to-day tasks are similar to something we have done before. Don't reinvent the wheel every time you start to work on something new!
Instead, we provide this standardized Hospital Incident Report Sample template with text and formatting as a starting point to help professionalize the way you are working. Our private, business and legal document templates are regularly screened by professionals. If time or quality is of the essence, this ready-made template can help you to save time and to focus on the topics that really matter!
Using this document template guarantees you will save time, cost and efforts! It comes in Microsoft Office format, is ready to be tailored to your personal needs. Completing your document has never been easier!
Download this Hospital Incident Report Sample template now for your own benefit!
BODY PART: Was there a safety procedure or mechanism available Yes No Was it in use at the time of incident Yes No Is the activity part of the normal job duties Yes No List names of anyone present at time of incident: Probable cause of incident (object or substance responsible for injury/illness): If indicated, what was discussed with employee to prevent recurrence Date: Supervisor Name: Extension: Employee’s Signature Beeper: Supervisor’s Signature Note: Any additional comments you feel are pertinent to an investigation of this incident can be made on a supplemental sheet and attached.. For Occupational Injury Clinic Use Only Inc Body Part Code: Disposition Full Duty Restricted Duty Referral (ER, WER, Ortho, Plastics, Etc) Recordable Yes Safety investigation requested No ICD9 DX Code Off Duty Restrictions not Accommodated RTC Scheduled RTC PRN as defined by OSHA Yes No If yes, comments: Healthcare Provider’s Signature/Title: Date JHH Form 15-1402020 5HY.
DESCARGO DE RESPONSABILIDAD
Nada en este sitio se considerará asesoramiento legal y no se establece una relación abogado-cliente.
Deja una respuesta. Si tiene preguntas o comentarios, puede colocarlos a continuación.
