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Keana Care Support ServicesStaff dashboard

Form05.

Incident Report

To be completed for ALL incidents and accidents where an injury has, or could have, resulted. Submit it as soon as practicable; it is then sent to the manager for investigation and closure.

0 of 13 required questions answered

Every question is required unless it is marked optional.

INCIDENT STATUS0/1

What is a reportable incident?

  • The death of a person with disability.
  • Serious injury of a person with disability.
  • Abuse or neglect of a person with disability.
  • Unlawful sexual or physical contact with, or assault of, a person with disability.
  • Sexual misconduct committed against, or in the presence of, a person with disability, including grooming for sexual activity.
  • Use of a restrictive practice that is not in accordance with a state or territory authorisation, or is used under that authorisation but not in accordance with the person’s behaviour support plan.
Incident status (required)

Did you identify the incident? (required)

How many people were involved in the incident / injury? (required)

Each person you choose here adds their own block below.

Was there any witness? (required)
Incident location (required)

What happened, in the order it happened. Stick to the facts.

Are there any details of physical injury? (required)

Choosing yes opens the injury questions.

Was a company vehicle involved in this incident? (required)
Did any property damage occur during this incident? (required)

Your report goes straight to the coordinator for review.