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Document Every Incident Completely the First Time

Incomplete incident reports are the #1 documentation deficiency in CMS surveys. This standardized form ensures nothing gets missed — from initial response through root cause analysis.

The Problem

Why this matters for your facility

Incident reporting in nursing homes is notoriously inconsistent. Different shifts document differently, critical details get omitted, follow-up actions aren't tracked, and root cause analysis rarely happens. When surveyors review your incident reports, they're looking for completeness, timeliness, and evidence of corrective action. Facilities with poor incident documentation face not just survey deficiencies — they face increased liability exposure in negligence claims where documentation gaps become evidence of negligence.

The Solution

What this template gives you

Our Incident Report Form is a structured Word document that guides staff through complete incident documentation. Every field has been designed based on what CMS surveyors and legal counsel look for in incident reports. The form covers all incident types common in SNFs — falls, medication errors, skin injuries, elopement, abuse allegations, and workplace injuries — with specific prompts for each category.

What's Inside

Here's exactly what you get when you download the Incident Report Form.

Structured fields for incident details: who, what, when, where, witnesses, immediate response

Category-specific sections for falls, medication errors, skin injuries, behavioral incidents, and workplace injuries

Notification checklist: physician, family, DON, administrator, state agency (if applicable)

Root cause analysis section with contributing factors and corrective action plan

Follow-up tracking: 24-hour reassessment, care plan updates, staff retraining documentation

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Who Is This For?

This template was built for:

Directors of Nursing who need consistent incident documentation across all shifts

SNF administrators preparing for surveys where incident reporting is a focus area

Risk managers looking to improve documentation for liability protection

Charge nurses and floor supervisors who are first responders to incidents

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Incident Report Form FAQs

Common questions about the Incident Report Form

Ready to Download?

Get the Incident Report Form and start improving your facility's compliance today.