Skip to main content Skip to navigation

Incident Report Forms

To report student, faculty or staff injury or harm, complete the WSU Incident Report found at .
This form is used throughout WSU to report a workplace injury or illness of a student, staff or faculty within twenty-four hours. Reference to this report is found in the undergraduate manual on pages 15 and 20. When submitted via the online system, the form goes to Human Resources and is reviewed by the Spokane campus safety committee. For students, faculty or staff who are harmed in a clinical agency, that agency’s report form may also be required.

To report injury, harm or near miss to a patient or client, complete the Nursing Commission Incident Report below.
AKA the critical incident report, this report is described on page 28 of the undergraduate student manual “…to report events involving a student or faculty member that the program has reason to believe resulted in patient harm, an unreasonable risk of patient harm, or diversion of legend drugs or controlled substances.” (WAC 246-840-513). When submitted via the online system, this report is directed to the “program director” the student indicates when completing the form.

  • Click the + sign to the right of each field to add additional names.
    Add a new row
  • Click the + sign to the right of each field to add additional names.
    Add a new row
  • Be detailed and keep to the facts. Include dates and times if known. If the incident was related to a medication, list the name of the medication, and the dose, time, and route of administration.
  • In your opinion, are there system improvements that could be made that might help someone else avoid this error or near miss in the future?
  • How will you change your practice to avoid this incident from occurring again in the future?
Washington State University