Medication Incident Form

A medication incident form for near misses, storage errors, medication given without consent, expired medication and adverse reactions. Staff complete it after the incident and a supervisor or manager reviews it. Administration errors use the separate medication error report.

What is inside:

• Incident details: dates, participant, location, staff involved and witnesses
• Incident type checklist, plus guidance on treating near misses with the same urgency as errors
• Medication involved, with prescribed and actual dose, route and time
• Chronological description of the incident
• Immediate actions taken and who was notified, with times
• Participant outcome and a contributing factors checklist
• Corrective action plan with responsible person and target date
• NDIS Commission reporting check, date reported and reference number, then staff and manager sign-off

Good to know: this form is an internal record. Where an incident is reportable, you still need to notify the NDIS Commission.

• Reviewed against the current NDIS Rules, Practice Standards and Commission guidance
• Editable DOCX with a placeholder legend, so you enter your details once
• Instant download

These templates are general information, not legal advice. No template can guarantee registration or audit outcomes.