Note: This form is for reporting of all near misses, adverse events, sentinel events

1. Kindly submit this form to Quality Department/MS Office
2. This form is not a part of medical record
3. The reporting is to ensure continuous quality improvement and is NON-PUNITIVE in nature.
4. All personal shall report on page 1 of the form within 24 hours of occurrence of an event and submit to respective HOD/Supervisor/In-charge
5. HOD/Supervisor/In-charge shall complete page 2 within 48 hours and submit to Quality/Ms Office
6. All category events must be analysed. Events in categories D to I must be subjected to root cause analysis.
7. Confidentiality of the person reporting should be maintained.
8. This form is for reporting of all near misses, adverse events, sentinel events.

1. All incidents like near miss, adverse event and sentinel events can be reported in this portal.
2. The reporting is to ensure continuous quality improvement and is NON-PUNITIVE in nature.
3. Quality/SPOC Quality will forward the incident to the respective department after a discussion with the Unit Head. SAC (severity assessment score) and Incident Category are to be identified before forwarding the incident.
4. Respective departmental head will analyse and put his/her remarks in the portal with appropriate closure evidence(s).
5. All near miss incidents are to be analysed and uploaded in the portal within 48 hours with appropriate Preventive Actions.
6. Analysis of Adverse events and Sentinel Events is to be completed within 7 working days and RCA (Root Cause Analysis) is to be uploaded in the portal.
7. Unit Head/Quality/SPOC Quality will review the closure and accordingly HOLD/RESOLVE & CLOSED the incident. If it is HOLD then repeat the RCA process.
8. Month wise consolidated reports are to be documented in the file with the Unit Head’s signature.