Children’s Home Society of Washington Critical Incident Report Form

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Questions and Answers

What is the primary purpose of the Critical Incident Report (CIR)?

  • To serve as part of a consumer's medical record
  • To document serious events or incidents involving consumers, staff, or property (correct)
  • To document staff injuries during an incident
  • To report security breaches and privacy violations

Which form should be used to report staff injuries?

  • Critical Incident Report (CIR)
  • Staff/Volunteer Accident/Injury Report Form (correct)
  • Breach Risk Assessment form
  • None of the above

Which form should be used to report security breaches?

  • Critical Incident Report (CIR)
  • Staff/Volunteer Accident/Injury Report Form
  • Breach Risk Assessment form (correct)
  • None of the above

What is the first step to be taken when an event occurs that may necessitate a Critical Incident Report?

<p>Manage the incident in consultation with your supervisor (A)</p> Signup and view all the answers

Who should review the Critical Incident Report within 5 days of the incident?

<p>The program/corporate manager or supervisor (B)</p> Signup and view all the answers

What is the final step in the process of completing a Critical Incident Report?

<p>Send the completed report to the Seattle Compliance Specialist (C)</p> Signup and view all the answers

What is the purpose of the Critical Incident Report form?

<p>To document any serious event or incident involving CHSW consumers, staff, students, volunteers or property (D)</p> Signup and view all the answers

What should be done if a Supervisor or Manager is not immediately notified about the incident?

<p>The incident should be documented on the Critical Incident Report form (A)</p> Signup and view all the answers

Which form should be used to report staff injuries?

<p>The Staff Accident/Injury Form (C)</p> Signup and view all the answers

What should be done if there is a security breach involving unauthorized persons and confidential information?

<p>Report it on the Breach Risk Assessment form, in collaboration with the HIPAA Privacy Officer (C)</p> Signup and view all the answers

What is required when filling out the Critical Incident Report form?

<p>Word processing of the form is required (C)</p> Signup and view all the answers

What should be done if the incident involves a consumer grievance?

<p>Document it on the Critical Incident Report form (A)</p> Signup and view all the answers

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