Download a copy of the ​Serious Clinical Incident Report form

Who should complete this report?

This form is for NGOs to report serious clinical incidents to their NSW Health funding and contracting agency (Local Health District and/or the Ministry of Health). An organisation may use their own serious clinical incident report provided that all required content from this report is addressed.
 

What is a serious clinical incident?

A serious clinical incident is an event or circumstance that occurs during service delivery which has had, or has potential to have, a significant impact on clients, staff and/or service delivery, or where serious physical and/or psychological injury or death has occurred or has the potential to occur.
 

Who to contact and send this report to?

Notice of a serious clinical incident is to be made to the organisation’s funding and contracting agency within 24 hours of the incident occurring. A Serious Clinical Incident Report is to be sent to the organisation’s funding and contracting agency within 72 hours of the incident occurring.
 
Questions relating to serious clinical incident reporting are to be directed to the organisation’s funding and contracting agency. Organisations with multiple NSW Health funding and contracting agencies must contact at least one of the agencies if there is a serious clinical incident.
 

Serious clinical incident management process​​

  1. Clinical incident occurs
  2. Immediate action taken to mitigate risks
  3. Clinical incident assessed as serious
  4. Notice of serious clinical incident made to NSW funding and contracting agency within 24 hours
  5. Document and report serious clinical incident to NSW Health funding and contracting agency within 72 hours
  6. Conduct internal review of the serious clinical incident
  7. Participate in NSW Health review of the serious clinical incident as required
  8. Implement strategies to address safety concerns and prevent incident reoccurrence
  9. Monitor clinical incidents and management practice

Incident classification guide with examples of clinical incident types

Organisations are to use discretion when classifying incident types and use this form to report serious clinical incidents to the funding and contracting agency. If organisations are unsure whether a clinical incident is to be reported, contact the funding and contracting agency for advice.
 
Organisations also need to report other serious incidents, such as those relating to misconduct, serious complaints, an event which may cause adverse publicity, termination of a contract by another government funding agency, or any current, pending or threatened reputational proceedings. Refer to the terms and conditions of the relevant funding agreement and/or contact the funding and contracting agency for advice.
 

Serious clinical incidents

An event or circumstance that occurs during service delivery which has had, or has potential to have, a significant impact on clients, staff and/or service delivery, or where serious physical and/or psychological injury or death has occurred or has the potential to occur.​
Serious clinical incident examples:
  • ​Death or near-death
  • Injury, self-harm, accident or assault, requiring medical attention and/or Police involvement
  • Alcohol and other drug use requiring medical attention
  • Alleged serious physical assault requiring Police involvement requiring Police involvement
  • Alleged sexual assault
  • Medication error resulting in significant harm
  • Property damage seriously impacting on alcohol and other drug and/or clinical service delivery
  • Confirmed COVID-19 (Coronavirus) outbreak (more than 1 linked case). Single COVID positive confirmed cases are only required to be reported in a short email to your contract manager (not a full incident report). 

Non-serious clinical incidents

An event or circumstance that occurs during service delivery which has had a minor and manageable impact on clients, staff and/or service delivery, and where no or minor harm has occurred.
​Non-serious clinical incident examples:
  • ​​Accident or injury requiring first aid or minor medical attention
  • Client missed medication, medication refusal or medication error resulting in no or minor harm
  • Client absconding, breaking curfew or not attending appointments / program
  • Alcohol and other drug use on-site which does not require medical attention
  • Client possession of alcohol, tobacco, or non-prescribed medication
 
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Current as at: Monday 21 February 2022
Contact page owner: Centre for Alcohol and Other Drugs