How are events reported to NCPS?
- Organization Member completes the form electronically, removing ALL identifying information about the patient or any of the healthcare personnel who were involved in the event.
- Organization Member completes as many fields in the form as possible, even if a root cause analysis was not conducted.
- Organization Member includes contributing factors, proximal causes, and actions taken to prevent future events, based on the investigation and follow up of the event.
- Organization Member saves the completed pdf in a secure location for their own records.
- Organization Member sends the completed form to NCPS via an encrypted email at: firstname.lastname@example.org
- NCPS acknowledges receipt of report to reporting Organization Member via email within one week.
NCPS Event Reporting Form
Writeable pdf form
If you are not a member of NCPS and have a question about reporting a patient safety event, please contact us by completing the form at the bottom of this page.