How could it have been handled differently? What action needs to be taken as a result of this ‘incident’? What lessons can be learnt for future reference? Registrar Signature: Date: Supervisor Signature: Date: Review of incident by Regional Head of Education and Director of Medical Education and Training. List the outcomes and actions arising from the review of this ‘incident’. DMET Signature: Date: Or RHE Please email completed form to your region below: Metro West: North West: North East: South West: FOR OFFICE USE ONLY: This form must be forwarded to the relevant RHE and copied to the Critical Incident Handling Officer.
How could it have been handled differently? What action needs to be taken as a result of this ‘incident’? What lessons can be learnt for future reference? Registrar Signature: Date: Supervisor Signature: Date: Review of incident by Regional Head of Education and Director of Medical Education and Training. List the outcomes and actions arising from the review of this ‘incident’. DMET Signature: Or RHE Date: Please email completed form to your region below: Metro West: North West: North East: South West: FOR OFFICE USE ONLY: This form must be forwarded to the relevant RHE and copied to the Critical Incident Handling Officer.
Form-Adverse-event-critical-incident-and-serious-issue-reporting-form-for-Incidents-involving-Registrars-v1.0-05.05.2017.docx