What counts as an incident
Your licensing rules and your program's policy define a reportable incident, and the definitions differ from state to state. Most programs include at least:
- Injuries to a resident, staff member, or visitor, and any that needed first aid or medical care.
- Physical holds, restraint, or any emergency safety intervention your rules allow.
- A resident leaving without permission, or not returning when expected.
- Medication errors: a missed dose, a wrong dose, a wrong resident, or a refusal that matters clinically.
- Self-harm, threats of self-harm, and suicidal statements.
- Allegations of abuse or neglect, by anyone.
- Police, fire, or emergency medical involvement.
- Serious property damage, contraband, and fights between residents.
When in doubt, write the report. An incident report that turns out not to be needed costs ten minutes; a missing one is a finding.
Who has to be told
An incident report is internal; a notification is what goes outside the building. Depending on the incident, your state, and the resident, that can include:
- The program director or on-call administrator, usually right away.
- The resident's parent or guardian, and the placing agency or caseworker.
- The state licensing agency, for incident types its rules list.
- The resident's health plan or the state Medicaid agency, where their rules require it.
- The state child abuse hotline or law enforcement, for suspected abuse or neglect.
That last one is not optional and is not satisfied by an internal report. Every state, the District of Columbia, and the US territories name in statute the people who must report suspected child maltreatment, and some, such as Iowa and Montana, name residential facility staff specifically.[1] Check your state's law and make sure every staff member knows the hotline number.
Record each notification on the report: who was told, by whom, how, and at what time. Reviewers check the timeline against the deadlines in your rules.
What every incident report includes
- When and where: date, start time, end time, and the exact location.
- Who: the residents involved, the staff on duty, and every witness.
- What came first: the event or situation just before.
- What happened: in order, with times, in observable terms.
- What staff did: each intervention, who did it, and how the resident responded.
- Injuries and care: what was seen, first aid given, and any medical follow-up.
- Notifications: who was told, by whom, how, and when.
- Follow-up: what happens next and who is responsible.
The person who saw it writes it, before the end of the shift, and signs it with the date and time. A supervisor reviews it and signs separately.
How to write it
- Facts, not conclusions. “Hit the wall twice with a closed fist” rather than “had a meltdown”.
- Times on everything. The order of events, and how long each part lasted, is usually the first question asked.
- Quote people. Threats, disclosures, and complaints of pain belong in quotation marks, exactly as said.
- Only what you saw. If someone else told you, say who, and ask them to write their own statement.
- No blame and no opinions about residents, staff, or families.
- Never change a signed report. Add a dated addendum instead.
A weak report, rewritten
This example is invented.
| Weak | Stronger |
|---|---|
| Resident got upset at dinner and became aggressive. Staff handled it. Mom was called. | At 5:45 pm in the dining room, staff told T. that second helpings were finished. T. said “this is so unfair”, stood up, and pushed his plate off the table. At 5:46 he kicked a chair toward peer R., striking R.'s shin. Staff J. Moreno directed the other residents to the living room; staff A. Lee stayed with T., kept her distance, and offered a walk outside. T. accepted at 5:52 and was calm by 6:05. R. had a red mark on the left shin, no swelling; ice applied at 5:50, nurse notified at 5:55. Program director notified by phone at 5:58. T.'s mother and R.'s guardian notified by phone at 6:20 by A. Lee. Behavior log completed for T. |
After the report
- Debrief with the staff involved, and with the resident when they are ready.
- Update the treatment plan or behavior plan if the incident changes what the team knows.
- Review incidents together every month for patterns: time of day, location, residents, and staffing.
- Close each follow-up item and record who closed it.
Free group home incident report template
One report per incident. Each resident involved may also need an entry in their own record.
Incident report
Program / site: ____________________
Report number: ______________
Written by: ____________________
Role / credentials: _____________
| Date, time, and location | |
|---|---|
| Residents involved (initials or identifiers) | |
| Staff and other witnesses present | |
| Type of incident | |
| What happened before (antecedent) | |
| What happened, in order, with times | |
| Staff response and interventions used | |
| Injuries, first aid, and medical follow-up | |
| Who was notified, how, and when | |
| Follow-up actions and who owns them |
Staff signature: ________________ Date and time: __________
Supervisor review: ________________ Date and time: __________
Template from dacnushealth.com/resources/group-home-incident-report. Adapt it to your state's rules and your program's policies.
Incidents in software
In Dacnus Clinical Records, behavior logs record the antecedent, behavior, and consequence with severity, duration, witnesses, and who was notified, on the resident's chart. Families see incidents through the guardian portal only when a staff member has switched that category on for their child. Views and edits of resident and clinical records, and every signature, are written to an audit trail with who, what, and when.