Beruflich Dokumente
Kultur Dokumente
Use this form to report accidents, injuries, medical situations, or student behavior incidents.
(Incidents involving a crime or trafc incident should be reported directly to the Campus Public
Safety ofce.) If possible, the report should be completed within 24 hours of the event. Submit
completed forms to the President’s Offce.
Description of Incident (what happened, how it happened, factors leading to the event,
etc.) Be as specifc as possible
(attached additional sheets if necessary)
I went to our new resident’s room “Ms. Lawry” who has a history of aggression when there is a
change in care provider or routine to introduce myself and get her to come out for breakfast. I
announced myself, and began to walk into the room and noticed her struggling to get up, I asked
“may I help you?” and began to put my hands on her shoulder to assist her. I unknowingly seemed
to have upset Ms. Lawry and she exclaimed “JUST LET ME DO IT!” and smacked the side of my left
leg with her walking cane.
Document any follow-up action taken after receipt of the incident report.