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How to Report

Reporting Safety Events

How are events reported to NCPS?

NCPS Organization Members with current, signed Member Agreements currently follow this process for submitting adverse event report using the writeable pdf form linked below.
  1. 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.  
  2. Organization Member completes as many fields in the form as possible, even if a root cause analysis was not conducted.  
  3. Organization Member includes contributing factors, proximal causes, and actions taken to prevent future events, based on the investigation and follow up of the event.
  4. Organization Member saves the completed pdf in a secure location for their own records.
  5. Organization Member sends the completed form to NCPS via an encrypted email at:   
  6. NCPS acknowledges receipt of report to reporting Organization Member via email within one week.
We encourage our Organization Members to report events and near events on a regular basis in order to maintain a robust reporting relationship. It is through this reporting relationship that the Organization Member's privilege and confidentiality protections are maintained.

NCPS Event Reporting 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.

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