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Incident Report Form

The student was late for her nursing duty due to a traffic jam caused by an accident. She informed the hospital of the delay and took responsibility for ensuring punctuality in the future. No injuries were reported.

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ybeca0214
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85 views

Incident Report Form

The student was late for her nursing duty due to a traffic jam caused by an accident. She informed the hospital of the delay and took responsibility for ensuring punctuality in the future. No injuries were reported.

Uploaded by

ybeca0214
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Incident Report Form

Student Name: WenMinYing Student No.: 12465501


Programm: Full-time:
Bachelor of Nursing with Honours in □ General Health Care □ Mental Health Care Higher
Diploma in Nursing Studies □ General Health Care □ Mental Health Care
Distance Learning:
Higher Diploma in □ Nursing □ Mental Health Nursing
Practicum: □ I □ II □ III □ IV □ V (For Full-time Programme Students Only)
Course Code: NURS N319F____
Hospital: KCH Ward/Unit: Exiters Specialty: Rehab

Details of Incident:
Date of incident: __26/2/24______________ Time of incident: __0830________________________
Client involved in the incident: □ Yes □ No
Age of the client:_____Nil_________________ Gender of the client: ________Nil_______________
Diagnosis of the client :___Nil_________________________________________________________

Description of the incident: (in details)


Reporting late for duty.
On 26/2/24, at approximately 0830, I encountered traffic jam while commuting to Duty. The traffic
congestion occurred on ShaTin . The jam was caused by an accident.

Incident Report Form (Revised Nov 2021) Page 1/2


Action taken during the incident:
I called KCH CND and told the staff I was late and could be arrived at around 15 minutes later.

Action taken after the incident:


I regret the inconvenience caused by the traffic jam that resulted in my delayed arrival to duty Despite
making efforts to mitigate the delay and keep all relevant parties informed, the circumstances were
beyond my control. I remain committed to ensuring punctuality in the future and will take appropriate
measures to prevent such incidents from occurring again.

Description of injury sustained (applicable to student):


Nil

Medical consultation (applicable to student):


No
Yes Date: Hospital/clinic:
Diagnosis:
Treatment:
Days of sick leave granted:
Field Coordinator informed:

Date: ___26/2/24______________________ Time: __2030___________________

Signature of student: _____________________________

Name of student: _Wen Min Ying____________________________

Date: ____26/2/24__________________
Send the completed “Incident Report” form to the course coordinator within 48 hours of the incident.
Incident Report Form (Revised Nov 2021) Page 2/2

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