1. Module 3 Completing a Client Incident Report form next Centre for Learning and Organisational Development

2. Incident reporting modules explained Hello and welcome to the on-line resources for critical client incident reporting and management. You are currently accessing Module 3. The following information outlines the content of this module and shows which other modules are available. Module 1 – What is incident reporting and why is it important? Module 2 – Incident types and categories Module 3 – Completing a Client Incident Report form This module provides an example of an incident and steps through each section of a Critical Client Incident Report form showing where to provide the necessary information to appropriately document the incident and complete the form. next At the end of each module you will be asked some multiple choice questions about what you have learnt

3. Let’s look at an incident It is 11am on 22 November—a Saturday morning. Alan, a staff member, walks into the room and observes Bob (another staff member) hitting Jim (a client). Alan quickly defuses the situation. Jim was not injured but felt very scared. Bob is asked to leave and the police are called. It is now Alan’s responsibility to complete a Client Incident Report. It is 11am on 22 November—a Saturday morning. Alan, a staff member, walks into the room and observes Bob (another staff member) hitting Jim (a client). Alan quickly defuses the situation. Jim was not injured but felt very scared. Bob is asked to leave and the police are called. It is now Alan’s responsibility to complete a Client Incident Report. Don’t hurt me Bob next I’m angry with you Jim!

4. Client Incident Report parts to be completed Part 1: Reporter’s Details Part 1: Reporter’s Details Part 2: Incident details Part 2: Incident details Part 4: What happened? Part 4: What happened? Part 3: Who was involved? Part 3: Who was involved? Part 5: Manager’s Report Part 5: Manager’s Report Internal DHS Review Parts 1- 5 completed: Forward Client Incident Report to the Designated Point at DHHS Parts 1- 5 completed: Forward Client Incident Report to the Designated Point at DHHS next The Client Incident Report form comes in three formats: Client Incident Report form with Macros (help text and pop up boxes) Client Incident Report form without macros (help text and no pop up boxes) Client Incident Report form to be completed by hand

5. Client Incident Report—Part 1: Reporter’s details 5 next Write the relevant DHS service area and the program that funds the service Add a reference number, if applicable Add the name of the agency reporting the incident Add the name of the service reporting the incident i.e. the name of the residential unit, foster care program, day program, housing site or youth service. Alan Thorn 9000 1234 Support Worker DHS East Inner Eastern Melbourne CYF YJ Youth Services 12345678 Department of Health and Human Services Corner Street, Residential Unit In this section record your name, telephone number and position title

6. Client Incident Report—Part 2: Incident details 6 Record the actual date and time of the incident If you did not see the incident, record the date and time you were first told about the incident Record the actual address where the incident occurred (such as the street address, park, or a specific room in house) Record the actual address where the incident occurred (such as the street address, park, or a specific room in house) Choose one incident type. Choose the incident type that best describes what happened during the incident or the behaviour or circumstances that had the greatest impact on the client If selecting physical or sexual assault, you must also select a box indicating the alleged perpetrator and the alleged victim. Carers and volunteers are ecorded as staff. If selecting physical or sexual assault, you must also select a box indicating the alleged perpetrator and the alleged victim. Carers and volunteers are ecorded as staff. Select a category for the incident: Category 1 is an incident that has resulted in a serious outcome such as client death or severe trauma. Category 2 is an incident that threatens clients or staff safety or health and wellbeing. Select a category for the incident: Category 1 is an incident that has resulted in a serious outcome such as client death or severe trauma. Category 2 is an incident that threatens clients or staff safety or health and wellbeing. For more guidance about choosing an incident type or category, refer to the Department of Human Services ‘Incident Type Categorisation Table’ For more guidance about choosing an incident type or category, refer to the Department of Human Services ‘Incident Type Categorisation Table’ next 22/11/201511.00 Living room in the Corner Street, Residential Unit Physical Assault

7. Client Incident Report—Part 3: Who was involved? In this section, only record details of clients involved in the incident The first client listed is the client most involved in the incident Medical professionals include allied health professionals, paramedics, and doctors The first person listed is the person most involved in the incident In this section, record the details of staff/carers/others involved in the incident Paid staff (P) includes employees, casual employees and volunteers. Carers (C) includes foster care/kinship carer/permanent carers DINMA is the department’s workplace safety reporting system—for departmental staff only next SimpsonBob Carr Jim ThornAlan 30/07/96 Cnr St, Residential Unit Was the person a Participant (P), Witness (W) or Victim (V) Was the person a Participant (P), Witness (W) or Victim (V) Youth Worker Was the person injured Yes (Y) or No (N) Youth Worker

8. Client Incident Report section—Part 4: What happened? This section must be completed by the staff member who witnessed the incident or the person who first heard about it. In this example: On 22/11/2015 I came into the lounge room and saw Bob (staff member) standing over and hitting Jim Carr (client). Jim had his hands over his head and was saying “Don’t hurt me”. I intervened and asked Bob to stop and leave the room. I asked Jim if he was hurt and checked him for injuries. Jim was not injured. Jim said that he was upset and felt scared. I reassured Jim that he was safe. I called David (Manager) and told him about the incident. Bob was asked to leave the house and not return. Police were called. Jim asked that his mum be called. Mrs Carr was contacted and has spoken with Jim. Don’t forget to record is any property or equipment was damaged The signature of the staff member is required (the person who completed sections 1-4 of the Client Incident Report) next 22/11/15.

9. Client Incident Report section—Part 5: Manager’s report This section needs to be completed by the House Supervisor, Coordinator, Manager, CEO, DAS Manager (as delegated in your organisation) This section needs to be completed by the House Supervisor, Coordinator, Manager, CEO, DAS Manager (as delegated in your organisation) Write a brief summary of the incident in approx. 20 words or less. The summary should give an overview of who was involved and the context of the incident e.g. client caused property damage by continuously hitting the walls. e.g. client disclosed to staff she had been assaulted e.g. client attempted suicide by……. e.g. client crashed the unit’s car Make sure that you document the actions taken in response to the incident List actions taken in response to the incident including actions to address safety concerns and what will be done to mitigate the risk that the incident will occur again. Include steps taken to address the client’s wellbeing, safety including support provided (referral to specialist services, review of support/care and/or communication plan, CASA) Include who has been contacted e.g. family, advocate, police, ambulance, doctor. Abuse in care refers to alleged or actual physical or sexual assault where the client in care is the victim and the perpetrator is a staff member, a carer or a member of the carer’s household Provide details relating to actions taken in relation to the incident; staff/carer stood down change of placement formal investigation or practice review recommended. next David Brown 9000 1235 Area Manager If you are reporting an allegation of assault, this section must be completed for clients of Child Protection and Disability Services

10. Client Incident Report section—Part 5 continued… This section is only for disability clients subject to compulsory treatment under the Disability Act (2006) who were involved or impacted by the incident This means clients subject to: Supervised treatment orders Registered treatment orders Parole Custodial orders This means clients subject to: Supervised treatment orders Registered treatment orders Parole Custodial orders Don’t forget to complete this section After the manager has checked that all sections have been completed properly, the manager needs to sign and date the incident report Fax the Client Incident Report to: 1300 734 633 Fax the Client Incident Report to: 1300 734 633 next 22/11/15 03:00pm 22/11/15 04:10pm Constable Plod 22/11/15 03:30pm If an incident involves alleged criminal conduct, it must be reported to police. Allegations of assault also must be reported to Police. If an incident involves alleged criminal conduct, it must be reported to police. Allegations of assault also must be reported to Police.

11. Where can I find out more? You can find out more by: Talking with your managerReading your organisation’s policies and procedures for incident reporting next Looking at the Critical Client Incident Management Instruction and support materials on the Funded Agency Channel.

12. Test your understanding Your manager should now provide you with a worksheet with multiple choice questions on the information you just learned. Please complete the sheet promptly. Thank you

13. To receive this publication in an accessible format phone 1300 799 470 select support option 1( for assistance with ebusiness),then select option 5 for funded agency channel, using the National Relay Service 13 36 77 if required, or email fac@dhs.vic.gov.au fac@dhs.vic.gov.au Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services February, 2016 Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. Available at www.dhs.vic.gov.au/funded-agency-channel/about-service-agreements/incident-reportingwww.dhs.vic.gov.au/funded-agency-channel/about-service-agreements/incident-reporting