When you complete the reporting form, you need to include details of the incident(s). Ask yourself:

• What happened?
• When and where did the incident(s) occur?
• Who was involved in the incident(s)?
• When were the incident(s) discovered or identified?
• How were the incident(s) discovered or identified?
• Who has direct knowledge of the incident(s)?

You will also need:

• The address of the facility where the incident(s) occurred
• Contact information for the person(s) who has knowledge of the incident(s) and the nurse involved
• The name and employment information (if you know it) of the nurse who is the subject of the report

We call the Contact Person listed on the form once we receive the report, to request additional evidence. This may include the letter of termination, if the nurse’s employment was terminated as a result of the incident(s).