This critical incident report form is used within HCBS to record occurrences that may compromise the service recipients' safety, health, or rights. Its structured format ensures that all pertinent details are captured accurately, including the type of incident, the individuals involved, and the immediate actions taken following the event. This allows for a consistent method of reporting across different services and locations within the HCBS framework.
HCBS provides support for people with disabilities or older adults so they can live in their communities rather than in institutions. OAAS is a department that oversees these services to maintain proper care and support.
The critical incident report example used within the HCBS setting consists of several parts:
- Participant identifying information. Name, address, date of birth, social security number, and other personal details to identify whom the report concerns.
- Incident categories. Abuse, neglect, exploitation, and other events, like major injuries or behavioral crises, need to be specifically reported depending on the age group of the participant (either 18-59 or 60 and older).
- Event information. When and where the incident occurred and immediate actions taken (e.g., notifications to Adult Protective Services or law enforcement).
- Health care admissions. Information about any healthcare services the participant was admitted to following the incident, such as psychiatric hospitals or emergency rooms.
- Reporting and follow-up. Specifies who reported the incident and any follow-up actions taken to address the immediate and long-term needs of the participant.
The support coordinator or direct service provider who observes or witnesses abuse should complete the critical incident report form. They are responsible for documenting the incident and ensuring that all necessary actions are taken immediately.
| Question | Answer |
|---|---|
| Form Name | Critical Incident Report Form |
| Form Length | 5 pages |
| Fillable? | Yes |
| Fillable fields | 70 |
| Avg. time to fill out | 15 min |
| Other names | critical incident form template, critical incidents report PDF, critical incident report example, DHH Louisiana critical incident report form |