Keep it short — a long form suppresses reporting. Capture what matters and route it fast.
| Date & time of event | |
| Location / department | |
| Reported by (role) | |
| Type (clinical / medication / fall / equipment / other) | |
| Severity (near-miss / minor / moderate / sentinel) | |
| What happened (factual, no blame) | |
| Immediate action taken | |
| Patient affected? Harm level | |
| NABH standard tagged | |
| CAPA required? (link ID) | |
| Reviewed by / committee & date |
A higher number of reported near-misses is a sign of a healthier safety culture — not a worse one.
© Acredify · Hospital Governance OS for India · founder@acredify.in · +91 91102 39430