What information should I collect for an Incident Report?
Incident Report Quick Reference:
What is an Incident Report: An Incident Report is a formal document used to report situations where a person has been injured or where a product is reported to pose potential injury to a person.
When to Complete an Incident Report: A person is injured, or a product is reported to present potential injury to a person. The report should be initiated as soon as the information is known, so the matter can be reviewed promptly by the Quality Assurance Department.
Questions to Ask When Inquiring About an Incident and Information Needed to Report an Incident:
Customer Account Information
- Customer Number
- Customer Account Name
- Complete Address
Order and Item Information (this information can also be found in PeopleSoft)
- Customer PO# if applicable (some customers use PO#’s for their documentation)
- Kaplan Order#
- Order Date
- Kaplan Item Number
- Item Description
- Price of Item
- Item Ship Date
- Invoice Number
Vendor Item Information (this can be found on the product, obtain when available)
- Vendor’s PO#
- Lot#
- Vendor’s Model#
Important Incident Details
- Injured Person’s Name
- Injured Person’s Age
- Location where the injury occurred (facility, area, room)
- Has the person returned to normal activities? (Yes / No)
- Describe concern for the person (optional)
- Has the person returned to the center? (Yes / No)
- Describe in detail how the incident happened
- Give a detailed description of the injury (injury site, severity, symptoms)
- Has the item been taken out of use? (Yes / No)
- Is the item available for inspection? (Yes / No)
Additional Information that can be obtained
- Contact Name (if different from caller)
- Contact phone number (if different from caller)
- Emails for communication
- Requested Photo’s
- Ask for Additional Comments if any
- Contact/parent expectation