List all incidents that occurred in the last year. Note key characteristics using the table below (add more lines if required). time of day staff member(s) individual(s) (morning, facility or incident type month involved use involved use – – afternoon, evening, location initials only initials only night) ANALYSIS OF INCIDENTS Are there any patterns apparent in the incidents listed above? Consider type of incident, persons involved, time of day / month, or location. If yes, please describe: Are any other apparent patterns or trends based on your review of the incidents? FOLLOW-UP ON LAST YEAR’S PLAN List the actions identified in last year’s plan and note any follow-up required. time of day staff member(s) individual(s) (morning, facility or incident type month involved use involved use – – afternoon, evening, location initials only initials only night) ACTION PLAN FOR COMING YEAR List the actions identified in last year’s plan and note any follow-up required. person(s) timeline for action responsible completion
List all incidents that occurred in the last year. Note key characteristics using the table below (add more lines if required). incident type month time of day (morning, afternoon, evening, night) staff member(s) involved – use initials only individual(s) involved – use initials only facility or location ANALYSIS OF INCIDENTS Are there any patterns apparent in the incidents listed above? Consider type of incident, persons involved, time of day / month, or location. If yes, please describe: Are any other apparent patterns or trends based on your review of the incidents? FOLLOW-UP ON LAST YEAR’S PLAN List the actions identified in last year’s plan and note any follow-up required. incident type month time of day (morning, afternoon, evening, night) staff member(s) involved – use initials only individual(s) involved – use initials only facility or location ACTION PLAN FOR COMING YEAR List the actions identified in last year’s plan and note any follow-up required. action person(s) responsible timeline for completion