Mandatory fields are marked with an asterisk (*)
Form date: 2.6.2023
Person filling in the form:
Date and time of the incident: *
Unit where the event occurred: Name of the hospital and the unit, outpatient clinic or ward where the patient safety event or a close call occurred. *
Event description: Please tell us what happened and how, and what were the consequences: *If possible, please include answers to the following questions in your report:What were people doing at the time?What happened and how?How was the event handled?What were the consequences to the patient?Please describe the conditions and other factors that caused the event as well.Do not include anything that makes it possible to identify the patient or staff members, for example a name or personal identity code. They should not be included for data protection reasons.
In your opinion, how could similar events be prevented in the future?