Incident report form
This form should be used to report any unintended or unexpected incidents which could have or did lead to harm for one or more patients receiving NHS-funded health care.
Please do not include personal identifiable information in your incident report including staff, patient, carer or relative names or addresses and patient hospital numbers.
Please refer to the Help section for further information about how to complete this form, who to contact for assistance and when incidents should also be reported to other organisations e.g. Medicines and Healthcare products Regulatory Agency (MHRA). Further information about how the NPSA will use you incident report is available on our website.
Pages to expect
The diagram below shows the pages you may encounter depending on the incident you are reporting. Look for a similar diagram at the top of each page to check your progress.