If an incident involving a facility staff member, or patient, results in the immediate or future harm (or risk of harm) to an individual as a result of an event, condition, action or inaction from the workplace staff member or patient, please fill out this form to report an incident to Clipboard's Trust and Safety Department.
Determining if a Safety Incident has occurred
Please fill out our Safety Incident report form if the answer to any of these questions is yes.
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Was there an instance of violence, physical abuse, or patient neglect?
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Was anyone physically harmed during the course of a shift?
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Are there any substance abuse or theft issues concerning you?
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Were any discriminatory remarks made to you?
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Did you experience any instances of sexual harassment?