Fall / Incident Report Builder

1Incident details

Resident name

NOK name

Date

Time

Location found

Witnessed status

How staff were alerted

Resident moved before assessment?

Mechanism (as reported / observed)

2Environmental factors

Floor condition

Footwear

Lighting

Mobility aid within reach?

Sensor mat status

3Head-to-toe assessment

Leave as "Not assessed" if genuinely not checked — this will be flagged as a gap, never assumed normal.

4Vitals & neuro obs

BP

HR

RR

Temp

SpO2

GCS

Pupils

Diabetic?

BGL (if taken)

Anticoagulant / antiplatelet

Weight-bearing status

5Transfer, escalation & notifications

How resident was transferred

Mobilised after, with

Escalation pathway used

RNIC GP VVED Ambulance/ED

ACD / Goals of Care

NOK notified?

GP review

Physio review

6Open disclosure & investigation

Open disclosure done?

With whom / how

Apology offered?

Falls risk / care plan reviewed?

Contributing factors observed

1Incident details

2Environmental factors

3Head-to-toe assessment

4Vitals & neuro obs

5Transfer, escalation & notifications

6Open disclosure & investigation

Generated IMS Write-up