Personnel involved (continue on separate sheet if necessary): Name Job Title Registration No Contact Details Role Check all Incident boxes that Detail apply Prescribing incident: Details of prescriber: Dispensing/supply Details of dispenser/supplier: incident: CD register discrepancy Details of discrepancy: against actual stock: Administration incident: Details of person administering: Missing CDs: Details: Record keeping: Details of record keeping: Security: Details of security: Suspected/Actual Details of criminality or fraud: criminality or fraud: Other (specify):
Personnel involved (continue on separate sheet if necessary): Name Job Title Registration No Contact Details Role Incident Check all boxes that apply Detail Prescribing incident: Details of prescriber: Dispensing/supply incident: Details of dispenser/supplier: CD register discrepancy against actual stock: Details of discrepancy: Administration incident: Details of person administering: Missing CDs: Details: Record keeping: Details of record keeping: Security: Details of security: Suspected/Actual criminality or fraud: Details of criminality or fraud: Other (specify):
NHS_Scotland_CD_incident_report_form.docx