CIRS (Critical Incident Reporting System)

First name

Last name

Email address

Create Event

Reporting area

Anti-Spam field

Description of the event

Suggestion for improvement

Details about the detector and the event

Professional category to the event

Relation

Date

Day

Month

Year

Hour

Minute

Risk Assessment

Frequency Harm

Potential

Personal Factors

Own illness / Private problems

Lack of expertise

Reduced Attention

Overload

Fatigue

Contributing to incident

Other personal factors

System Factors

Material/Equipment problem

Lack of staff

Unfamiliar working environment

Time pressure because of organisational reasons

Time pressure because of possible patient hazard

Other system factors

Team Factors

Within the treatment team

Interdisciplinary

With patients

Unclear responsibilities

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Textfeld

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