Event reported by
Select a location/service
Event Date and Time
Incident title
Who is reporting this event?
Name of Support Worker / Agency Worker
Select name of Service User
Name of other Resident
Service User Date of Birth
Give detail of the circumstances of the death and any other relevant information
Was the death expected or unexpected?
Expected
Unexpected
Select an option
Was the death the expected outcome of an illness or medical condition?
No
Yes
You cannot complete this step as it is not assigned to this user.
Were staff present at the time of death?
No
Yes
You cannot complete this step as it is not assigned to this user.
Please list all staff on duty at time of the death
*
Add Staff on duty
you must provide this information
Please save the data or click cancel
Please list all staff on duty at time of death
Name of other staff member
Please upload statement from staff member
Choose file...
Save
Cancel
Please list all staff on duty at time of death
{6c321eed-721c-40fa-9036-393f17a6d6ce}
Name of other staff member
{Staff_new_employee_details}
Please upload statement from staff member
{b1083a85-e392-4ee5-8e40-5b0756b9fa49_name}
What is the seriousness of this event?
Serious - This covers all deaths
Select an option
Submit