Incident Report Form

At Vibrant Community Health, we are dedicated to ensuring the safety and well-being of our clients, staff, students, volunteers, and visitors. It is crucial to report all incidents, no matter how minor they may appear. By documenting each incident, we can build a comprehensive profile of potential risks affecting our community.

Reviewing the patterns and trends of these incidents helps us identify underlying risks and implement corrective measures to prevent future occurrences. Your detailed and accurate reporting is essential in maintaining a safe environment for everyone involved.

Incident Reports should be filed if one or more of the following incidents occur during working hours:

  • A staff, client volunteer or vendor is injured during work hours

  • Medical emergency

  • Property damage/vandalism

  • Near miss: something that could have harmed a staff/client/volunteer but did not in this instance

  • Physical or verbal violence, harassment or threats

  • Pest issue (bud bugs, cockroaches, mice, etc). 

  • Privacy or security breach

  • Theft

  • Power/system outage

  • Critical incident (fire, flood, gas leak, death)

Incident reports should not be submitted when:

  • A Primary Care Provider decides to call 911 for a medical emergency

  • Someone is using drugs in the bathroom

  • Someone spending too much time in the bathroom/on the phone