KBTH PATIENT/STAFF INCIDENT NOTIFICATION FORM
Consistent with the global and national patient/staff safety agenda, KBTH seeks to improve upon the safety of care that is provided to its patients/staff. In view of that, the hospital seeks to learn from the occurrence of adverse events/incidents and design effective systems to avert any future occurrence. Whatever information you have provided will be solely used for the intended purpose of improving the quality and safety of care. Thank you for your support in improving the quality of care outcomes.
Sign in to Google to save your progress. Learn more
SECTION A: GENERAL BACKGROUND INFORMATION 
Category of person involved
Clear selection
Folder Number
Age
Sex
Clear selection
Department *
Other (State below)
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy