West Cheshire GP Incident Report Form

Use this form to record both events/incidents and near misses.

Record only known facts.

A icon denotes a mandatory field and must be completed.

A appears next to any fields where you can select as many values as you wish. To make your selections, click the icon that appears below the field.

If you require assistance or training in the use of this form, either as a reporter or manager, please contact Insight Team on mlcsu.insightteam@nhs.net to arrange a training session or support in completing the form.

    1. General Information
    1. Incident Details
      Information about where, when, what the incident was and any immediate action taken
    1. Common Classification System (CCS)
    1. Risk Grading
    1. Details of person reporting the incident