Incident Reporting

Per the guidelines set forth in 65D30.04

(17) Critical Incident Reporting Pursuant to Section 397.4103(2)(f), F.S.

(a) Every provider shall develop policies and procedures for submitting critical incidents into the Department’s statewide designated electronic system specific to critical incident reporting.

(b) Every provider shall report the following critical incidents within 24 hours of the incident occurring.

1. Adult Death. An individual 18 years old or older whose life terminates:

a. While receiving services; or

b. When it is known that an adult died within thirty (30) days of discharge from a program.

When reporting overdoses and/or life-threatening events please be as detailed as possible including only factual information.

Company

First Name

Last Name

Address of Incident

Date of Incident

Approxiate Time of Incident

Describe the Incident

What actions were performed, i.e. CPR, Narcan, 911, Etc?

What were this person’s “drug of choice”, if applicable?

Were there any pertinent behaviors prior to the incident or overdose that you can recall? What were those behaviors?

If called, how soon were emergency responders called and how long did it take them to arrive?

Was anyone notified other than emergency responders?

What has been or will be done to assess and address the community in the aftermath?

Gender of Client, if applicable

Male

Female

Non-Binary

Age

What State did they come from, if non-resident?

How long have they lived in FL, if non-resident?

Why did they come to FL, if non-resident?

Thanks for your submission

NARR Standard 3.0

19. Plan for emergencies including intoxication, withdrawal, and overdose

a. Verification that emergency numbers, procedures (including overdose and other emergency responses), and evacuation maps are posted in conspicuous locations.

b. Documentation that emergency contact information is collected from residents.

c.Documentation that residents are oriented to emergency procedures.

d.Verification that Naloxone is accessible at each location, and appropriate individuals are knowledgeable and trained in its use.