Incident Report Form
This form is for Health and Wellness Services staff only.
Use this form to report an incident or near miss event including injuries, unexpected outcomes, breach in procedure, privacy incident or safety issue.
For incidents or near misses causing harm or potential harm or injury to patients or staff please submit your report within 24 hours of discovery.
For incidents such as unexpected outcomes, breach in procedure, privacy incident or safety issue. Submit your report within three business days of discovery.
Use this form to report an incident or near miss event including injuries, unexpected outcomes, breach in procedure, privacy incident or safety issue. Please see policy HWS Incident Reporting policy if unsure of the reporting requirement. Contact whccompliance@colorado.edu with any questions. Submit your report within three business days of discovery.