Directorate / Team Email Contact Number Line Manager Incident Details Date of Incident Time of Incident Incident Location Incident Description (Give a brief description of the incident. If equipment was involved give as much information as possible) What type of Incident Near Miss Incident is it? Type of CCG Staff Equipment / Information Visitor incident/person Member Premises / Security / affected? IT systems failure Data Breach Did the incident Yes No result in staff absence? Were there any other witnesses? (if relevant) Email the completed form to the
Directorate / Team Email Contact Number Line Manager Incident Details Date of Incident Time of Incident Incident Location Incident Description (Give a brief description of the incident. If equipment was involved give as much information as possible) What type of Incident is it? Incident Near Miss Type of incident/person affected? CCG Staff Member Equipment / Premises / IT systems failure Information Security / Data Breach Visitor Did the incident result in staff absence? Yes No Were there any other witnesses? (if relevant) Email the completed form to the
6.MCCG%20Incident%20and%20Nr%20Miss%20Policy%20March%202016.docx