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Welcome to the NC Incident Response Improvement System
Print Blank Incident Report
All Forms
By Type of Incident
Provider Information
Allegation of Abuse, Neglect, or Exploitation
Incident Information
Consumer Behavior
Consumer Information
Suspension / Expulsion
Death Information
Fire Information
Restrictive Intervention
Authorities Contacted
Injury Information
HCPR Facility Allegation Information
Medication Error
Include Supervisor Actions
Select the Type of Incident
Death
Restrictive Intervention
Injury
Medication Error
Allegation of Abuse, Neglect or Exploitation
Consumer Behavior
Suspension / Expulsion
Fire
HCPR Facility Allegation Without Consumer Involvement
Version: .NET 4.6
Created: April 2010
Modified: June 2021