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The School of Nursing Adverse Event, Near Miss and Critical Incident Reporting Form and Database

Data is collected in the online form and is used to examine patient safety events involving students and/or faculty.  You might be involved in the event directly or as a witness.  The School of Nursing enters your information into the database and analyzes it for trends.  Nursing programs will adjust curriculum based on identified trends.  By reporting events from your viewpoint as a ‘guest’ in health care environments you fulfill legal and ethical professional responsibilities and contribute to advancing the culture of safety.

Data is not used for student evaluation; therefore your submission of data will not jeopardize your standing or progress through your nursing program.

Depending on the nature of the safety event, completing this form will take between 5 and 20 minutes of your time.

You have used your Saskatchewan Polytechnic username and password to log into mySaskPolytech and open the form, but this information will not appear on the report.  All participants will remain anonymous and no identifying information will be collected.  Identifying data that is entered without your intention will be removed by the database administrator.

Forms that are incomplete will be omitted from data collection.  This form is not meant to be a substitute for the Health Regions’ usual occurrence report forms.​