Incident Report

Step 1 of 3

A serious incident is any event or circumstance that jeopardizes the health, safety or well-being of the client, family member or employee of Pavo Behavioral Therapy LLC LLC. Examples of a serious incident include, but are not limited to, abuse or neglect; criminal behavior; death, emergency medical treatment; facility-related issues, such as fires, flood or destruction of property; food-borne diseases; serious infractions of facility or school rules; physical assault or other dangerous acts of aggression; sexual misconduct or assault; use of illicit or dangerous substances; serious illness (such as tuberculosis, meningitis or other communicable diseases); physical injury (accidental or otherwise); medication errors or client refusal of medication; attempted suicide; and unexplained absence.
Date of the incident(Required)
Who was injured? (Check all that apply)(Required)