Critical Incident Follow-Up For CCSS staff use only. This form documents follow-up actions once an incident has been resolved. Home Share Providers: this section will be completed by your Home Share Coordinator. Full Name: Email Address: CCSS Resource: Nelson - V&A Nelson - C&D Trail - L&C Trail - A&C West Kootenay Home Share East Kootenay Home Share Community Support None Date of Incident: Person Supported: Personnel/Home Share Provider: Type of Incident: Please select your answer Emotional Abuse Financial Abuse Physical Abuse Sexual Abuse Neglect Restraint Restriction of Rights Aggression Between Individuals Aggressive/Unusual Behaviour Attempted Suicide Choking Death Disease/Parasite Outbreak Fall Medication Error Missing/Wandering Misuse of Illicit Drugs or Licit Drugs Motor Vehicle Injury Other Injury Poisoning Service Delivery Problem/Disruption of Services Unexpected Illness/Food Poisoning Use of Seclusion Weapon Use Details of Incident: Resolution: Previous Critical Incident Follow-Up Next Time's up
