Date:		
Area(s) examined:		
Follow-up actions:		

RATING CRITERIA	
Not Observed	Low	Medium	High	
NA	1	2	3	
Incident and event reporting policies	Observations	Rating	
1.	What do we already do to encourage staff to report incidents and events? How can we further encourage staff to report incidents and events?			
2.	Do we have a policy on incident and event reporting? Does this policy reflect best practice approaches such as ‘just culture’—balancing accountability with safety?			
Methods of Reporting:	Observations	Rating	
3.	What process do we require staff to follow if they want to report an incident or event? Do they use reporting forms or simply report it to their supervisor?			
4.	Can we make our report forms easier to fill out while still ensuring they still capture sufficient information about the primary and contributory causes of incidents or events?			
Review of event and incident information:	Observations	Rating	
5.	Do we review and analyse information from incidents and events to identify contributory causes and areas of improvement?			
6.	Do we look at common themes between several reported incidents and events to identify common causes or weaknesses? 			
7.	How can we further maximise the lessons we learn from incidents and events?			
Implementing preventative measures:	Observations	Rating	
8.	Do we identify follow-up actions to prevent future incidents or events, and do we involve staff in the development and implementation of these control measures?			
9.	Have we closed out all actions within a reasonable time frame?			
Auditing of control measures:	Observations	Rating	
10.	Do we audit the control measures we implement to ensure they are actually being applied in practice and adopted by staff?			
11.	Is there a way we can better assess whether our updated processes or procedures are in-fact working in practice?			
ACTIONS:
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