Name/Date:____________________________________________

1. List three things that are decreased with good incident reporting.

a. _____________________________________________________________________

b. _____________________________________________________________________

c. _____________________________________________________________________

2. List four purposes of incident reports.

a. _____________________________________________________________________

b. _____________________________________________________________________

c. _____________________________________________________________________

d. _____________________________________________________________________

3. List five things that should be reported

a. _____________________________________________________________________

b. _____________________________________________________________________

c. _____________________________________________________________________

d. _____________________________________________________________________

e. _____________________________________________________________________

4. What happens to your report after it is filed?

_____________________________________________________________________

_____________________________________________________________________

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