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Form

Adverse incident and near miss report form

Published on 13 April 2021

From: NHSScotland Assure

Form for reporting adverse incidents and near misses in the workplace.

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The adverse incident and near miss report form should only to be used when it is not possible to use the standard webform, e.g. when local IT security measures prevent access. Refer to our Incident reporting section for more information on reporting adverse incidents.

This form can be used to report adverse incidents and near misses involving medical devices, social care, estates and facilities equipment used in Scotland’s health and social care services.