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Critical Incident Report Form

Critical Incident Report Form Template for Ireland

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Key Requirements PROMPT example:

Critical Incident Report Form

"I need a Critical Incident Report Form for our Dublin-based hospital that complies with HSE guidelines and includes specific sections for patient safety incidents, to be implemented by March 2025."

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Document background
The Critical Incident Report Form is a essential document used across Irish organizations to fulfill their legal obligations under the Safety, Health and Welfare at Work Act 2005 and related regulations. It serves as a standardized method for documenting serious workplace incidents, accidents, near-misses, and dangerous occurrences. The form must be completed promptly following any critical incident and includes detailed information about the event, affected parties, immediate responses, and required notifications. This documentation is crucial for regulatory compliance, risk management, insurance purposes, and implementing preventive measures. The form also ensures that organizations maintain appropriate records for the Health and Safety Authority (HSA) and other relevant authorities while adhering to GDPR and Irish data protection requirements regarding personal information handling.
Suggested Sections

1. Incident Overview: Basic details including date, time, location, and type of incident

2. Reporter Information: Details of the person completing the form including name, role, contact information

3. Persons Involved: Information about all individuals involved in or affected by the incident, including staff, patients, visitors, contractors

4. Incident Details: Detailed description of what happened, including sequence of events and immediate actions taken

5. Injuries/Damage Assessment: Description of any injuries to persons or damage to property/equipment

6. Immediate Response Actions: Steps taken immediately following the incident to secure safety and prevent further harm

7. Witness Information: Details of any witnesses to the incident, including contact information

8. Notification Record: List of authorities, management, or other parties notified of the incident

9. Initial Risk Assessment: Preliminary assessment of the severity and potential consequences of the incident

10. Declaration: Signature section confirming accuracy of report and data protection notice

Optional Sections

1. Medical Response Details: For incidents involving medical emergencies or healthcare settings - details of medical intervention provided

2. Environmental Impact: For incidents involving environmental hazards or spillages - assessment of environmental impact

3. Equipment/Machinery Involved: For incidents involving equipment failure or machinery - technical details and maintenance history

4. Security Breach Details: For incidents involving security breaches - specific security-related information

5. Media/Communications Log: For high-profile incidents - record of media contact and external communications

6. Financial Impact Assessment: For incidents with significant financial implications - initial cost assessment

Suggested Schedules

1. Incident Classification Guide: Reference guide for categorizing type and severity of incidents

2. Emergency Contact List: List of emergency contacts and reporting authorities

3. Body Map: Diagram for marking location of injuries when applicable

4. Scene Documentation: Templates for photographing/documenting incident scene

5. Risk Matrix: Tool for assessing and scoring incident risk level

6. Mandatory Reporting Guidelines: Reference guide for incidents requiring mandatory reporting to authorities

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓƵ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions






























Clauses






















Relevant Industries

Healthcare

Manufacturing

Construction

Education

Retail

Hospitality

Transportation

Financial Services

Technology

Public Sector

Pharmaceuticals

Energy

Agriculture

Mining

Telecommunications

Relevant Teams

Health and Safety

Human Resources

Operations

Security

Compliance

Quality Assurance

Risk Management

Facilities Management

Emergency Response

Occupational Health

Legal

Environmental Health

Senior Management

Employee Relations

Training and Development

Relevant Roles

Health and Safety Manager

Facility Manager

Department Supervisor

Human Resources Director

Risk Management Officer

Operations Manager

Security Officer

Compliance Officer

Quality Assurance Manager

Site Manager

Project Manager

Shift Supervisor

Department Head

Environmental Health Officer

Emergency Response Coordinator

Occupational Health Nurse

Safety Representative

Line Manager

Chief Operating Officer

General Manager

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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