Patien safety event report by a patient

Mandatory fields are marked with an asterisk (*)

Form date: 2.6.2023

   Patient   Relative

Date and time of the incident: *

  • 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.