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Incident Reporting Texas 20-22021 1 Hour Back to Course Index









In a health care facility, such as a hospital, recovery center, nursing home, or assisted living, an incident report is a form that is filled out in order to record details of an unusual event that occurs at the facility, such as an injury to a patient or client.

images-2What is the Purpose of an Incident Report?

Incident reports should not be used to blame or punish staff but rather to learn areas of concern and better approaches to client/patient safety. 

Incident Reports are used to communicate information to other people and to document significant events within individual records and as required by state standards.  People often use the information obtained from incident reports when formulating plans or profiles, to develop support strategies, and when making decisions.

Consequently, it is extremely important for the content of the Incident Report to reflect clear information in a factual, unbiased manner to avoid passing along opinions and judgments.  What a staff person has to say concerning an incident is essential to other people who are trying to understand what has happened and why it occurred.

Staff should re-read the reports that they have written prior to submitting them to ensure that they are legible, have been completed properly and that the report truly states what the writer has intended to convey.  All sections of the report must be completed (avoid leaving blanks).  Incident Reports are legal documents that the individual may view, their guardian, designee, or legal representative, and may be utilized by courts.  Be sure to use the full name of staff or providers when referencing them in a report; initials of staff/providers are not sufficient.

imgres-7When Should An Incident Report Be Written?

Staff should prepare an incident report to document unusual and/or significant events or emergencies involving individuals who receive services and/or support.  Examples of such events include but are not limited to the following:





  • Injury to an individual
  • Aggressive behavior directed at others
  • Self-abusive behavior
  • Endangering or threatening others
  • Serious illness and/or hospitalization
  • Imminent death or death
  • Property destruction
  • Serious disruptive situation while in the community
  • Illegal or unusual problematic behavior
  • Being victimized by another individual who receives services
  • Any incident involving the police, fire department, ambulance, etc.
  • Any time someone has physically intervened with an individual when such intervention is not in accordance with an approved behavioral treatment plan
  • Any time an individual is involved in an automobile accident while receiving services
  • Being a victim of a crime reported to a law enforcement agency;
  • Being incarcerated (in jail or prison for at least one overnight stay);
  • Others should note significant accomplishments or other positive changes.

If you are unsure about whether or not to complete an incident report, complete one.

If an incident involves the behavior/injury of more than one individual, separate reports are necessary.  Be sure that you do not include confidential information about others on an individual’s report.

images-1Writing an Incident Report

First and most important, don’t delay.  Obtain the proper documentation as soon as possible and fill out the details as clearly as you can remember.  Make sure to outline:

-The name and address of the organization.

-The concern in one or two pages, including:

Who – Who was involved in the incident?

What – What exactly happened?

When – When did the event occur; note the specific date and time.imgres-5

Where – Where did the situation occur?

How – How was the situation or event handled?

Safety – Also, remember, if the situation warrants it, implement a safety plan and note what you did to keep everyone safe.


Each person writing an Incident Report should consider the following:

Cause of Incident:

Make every attempt to provide only factual information.  Even if the actual cause of an incident remains unknown after you have attempted to determine it, you should give as much information as you have concerning what happened before the event/during the event, as this may provide a clue to the reader.  If you did not witness the incident or event, you might still write an Incident Report; however, be sure to state that the information is based on what was reported to you and by whom it was reported.


Describe the incident in concrete, behavioral terms.  Do not use generalities…be specific.  Review your report to verify that you have not used judgmental terminology or left unanswered questions.  It is best to prepare an Incident Report immediately following the incident while the facts are still clear.  However, staff may still be emotionally involved at that time, so it may be helpful to have another person review the report prior to it being submitted.

Please remember that your description of the incident is what other people will rely on to obtain information concerning the individual and the incident.  It is important that your report does not convey negative images of you or the individual when a more neutral one should be conveyed.  Examples: stating someone stole food out of the refrigerator when the individual took food out of the refrigerator.  Your report has the ability to influence others, so it is important that it is properly prepared and provides a factual accounting of the incident.

Reliability of your observation:

Would other people seeing or hearing the incident agree with the account that you have written?  If another person was involved in the incident or witnessed it, consult with that person to ensure that the report concurs with that person’s observations.  When writing your report, use terms that are specific and clearly describe the behavior that occurred.  For example, don’t use generalities such as aggressive/upset/agitated, state the behavior that you observed that made you believe the person was being aggressive, was upset, or agitated.

Objectivity: When writing your report, be sure that you have not allowed an earlier situation or prior information to influence your perception of the current incident.  You are writing your report as a recorder, not as a judge.  Consequently, be sure that your report is free from judgmental statements, sarcasm, or condescending comments.




Texas Health and Human Services Form 6108, Substance Abuse Treatment Facility Incident Report

Form 6108 is used to notify the Texas Health and Human Services Commission (HHSC) of an incident and the actions taken by the facility. 

This form must be submitted within two business days of the incident.  A form should be submitted for each incident separately and multiple incidents should not be included in one document.

The process of filling out the form should explain how the facility will improve care as a result of the incident. Complete the entire form with all requested attachments so that HHSC may review the incident without requiring additional information or documents.  The form is used to both notify Texas Health and Human Services Commission (HHSC) of an incident and the actions taken by the facility.

Submit each completed form by ONE of the following (email, fax or mail):

Email: [email protected]
Fax: 1-833-709-5735 or 512-206-3985
Mail: Texas Health and Human Services Commission
Complaint and Incident Intake
P.O. Box 149030, Mail Code E-249
Austin, TX 78714-9030

Print or type the information and provide as much information as possible. Use the facility name and license number as listed on your license.


Reportable Incident – Check the appropriate box from the following:

  • Abuse
  • Neglect
  • Exploitation

Date of Report – Enter the report date.

Date of Incident – Enter the date of the incident.

Time of Incident – Enter the time of the incident and check A.M. or P.M.

Facility License No. – Enter the facility license number.

Facility Name – Enter the name of the facility.

Address – Enter the street address, city, state, ZIP code.

Telephone – Enter the area code and telephone number.

Reporter Name and Title – Enter the contact person and title that the surveyor will ask for should a follow-up telephone call be needed.

Primary Phone No. and Secondary Phone No. – Enter the area code and telephone numbers.

Email – Enter the email address.

Client Name – If the incident involves a client, enter the first, middle and last name.

Date of Birth – Enter the client’s date of birth.

Date of Admission – Enter the date the client was admitted.

Date of Discharge – Enter the date the client was discharged.

Diagnoses (all) – Enter the diagnoses.

Discharge Disposition – Check the box for home, hospital or other. If other, enter the other disposition.

Facility Name and City – Enter the name of the facility and city.

Perpetrator Name and Title – Enter the perpetrator’s name and title.

Perpetrator License No. – Enter the perpetrator’s license number.

Social Security No. – Enter the perpetrator’s Social Security number.

Telephone – Enter the perpetrator’s area code and phone number.

Address – Enter the perpetrator’s street address, city, state and ZIP code.


When did you first learn of the incident? – Enter the date and time.

On what shift did the incident occur? – Check the box for day, evening or night.

Provide a brief summary – Enter what happened, who was involved (e.g., RN, LVN, PCT, MD, other), and the action taken at the time of the incident.

Did the client receive any treatment? – Check Yes or No. If yes, explain.

Was this reported to law enforcement? – Check Yes or No.

Was this reported to another organization? – Check Yes or No. If yes, provide the name of the organization.

Provide a narrative report of the investigation  Explain how you handled the incident and what actions you will take to reduce the potential for similar incidents in the future.

Actions to be taken as a result of this incident – Check all boxes that apply.

Signature, Printed Name and Date – The supervising authority signs, prints his/her name and enters the date. Then, email, fax, or mail the completed incident form to the number or address provided above under Transmittal.

Patients or clients can also make a complaint against a facility.  When they make a report they should include:

  • Thier name, address, and telephone number. Every effort is made to protect their confidentiality; however, they must provide this information if requested in accordance with the Public Information Act. Or, you may make a complaint and remain anonymous.
  • The name, address, telephone number, and date of birth or age of the patient(s)/client(s) referenced in the complaint.
  • Date(s) of incident(s).
  • Specify all facts directly related to the incident(s) being reported.

A patient complaint against a substance abuse or narcotic treatment facilities should be sent to:

  • Complaint hotline: 1-800-458-9858 Option 6

  • Email[email protected]

  • Fax: 833-709-5735

  • Mailing address:

    Health and Human Services Commission
    Complaint and Incident Intake
    Mail Code E-249
    P.O. Box 149030
    Austin, Texas 78714-9030

images-9The Joint Commission on the Accreditation of Healthcare Organizations

  • In 1995, hospital-based surveillance was mandated by the Joint Commission because of the perception that incidents resulting in harm were frequently occurring.  The Joint Commission employs the term sentinel event in lieu of a critical incident and defines it as follows:
  • An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.  Serious injury specifically includes loss of limb or function.  The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.
  • As one component of its Sentinel Event Policy, The Joint Commission created a Sentinel Event Database.  The database accepts voluntary reports of sentinel events from member institutions, patients and families, and the press.  The particulars of the reporting process are left to the member healthcare organizations.  The Joint Commission also mandates that accredited hospitals perform root cause analysis of important sentinel events.  Data on sentinel events are collated, analyzed, and shared through a Web site, an online publication, and its newsletter, Sentinel Event Perspectives.

images-10How Do You Submit An Incident Report

  • Your organization should have its form to use for incident reporting.  If not, create one with the required information included:
  • Organization Name
  • Organization Address
  • Reporters Name
  • Incident Date
  • Incident Narrative

The preferred method for submitting a patient safety concern to The Joint Commission is through our online submission form as it allows for more direct, timely receipt and review of your concerns.

By policy, The Joint Commission cannot accept copies of medical records, photos or billing invoices and other related personal information. These documents will be shredded upon receipt.



Patient safety is a priority.  Documentation of patient care holds the healthcare team members to professional accountability and demonstrates the quality care you have given.  When the unforeseen happens, and sometimes it does, the reporting of incidents can help identify will potential issues are.  We need to focus on a blameless reporting atmosphere where healthcare providers feel safe making reports.  Speak up if you have questions regarding your workplace or see areas of concern.