Mandatory reporting & documentation
Within one (1) working day after discovering a reportable incident, the Facility Medical Director must notify CPSA at nhsf@cpsa.ab.ca.
Within two (2) weeks of the incident, the facility must submit this form.
This information is being requested under the authority provided by Section 8.2(3) of Schedule 21 of the Health Professions Act.
Information required to complete this form
Please expand each of the accordions below for details about what you need to complete this form.
1. General Information
To complete this form, you will need to provide us with:
- Facility name and number
- Medical Director name
- Date CPSA was notified of the incident
- Type of incident
- Date of procedure
- Date of incident
2. Procedure Information
- The procedure proposed and performed
3. Incident Evaluation
- Details about facility staff member completing the Incident Report form
- Medical Director evaluation of incident
|
|
Please be advised of the following changes:
|
