Incident Management at Clipboard Health for Our Partner Facilities

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At Clipboard Health, we have a rigorous system in place for Incident Management. Here are some instructions on when to file a report, what to include in it, and how to file it.

When to File an Incident Report

Incidents regarding health care workplace conduct and patient care and treatment may include, but are not limited to, the following:

  • Behaviors which likely expose a patient or other person unnecessarily to the risk of harm
  • Unprofessional or unethical conduct by a Health Care Professional or Facility, including all types of harassment and discrimination.
  • Failure to adequately care or treat a patient, along with patient neglect. 
  • Failure to conform to the minimum standards of acceptable health care practices
  • Impairment or likely impairment of the Health Care Professional’s practice by chemical dependency, alcohol, or mental illness
  • Failure to comply with OSHA’s standards of creating an unhazardous or sanitary workplace environment 
  • Any violation of HIPAA, including sharing private patient data with Clipboard Health

Clipboard Health does not normally address “general complaints” that can be handled at the Facility-level such as petty behavior issues. 

What to Include in an Incident Report

When filing a complaint, please provide:

  • The identity of the Health Care Professional involved, including the correct spelling of the name, and the Health Care Professional’s license number or last four of social security number, if known, to assist us in identifying the Health Care Professional in the event of a common name. 
  • Also, please provide a detailed summary of each alleged violation, including dates and times of each alleged incident. If the incident involves a medication, include the name of the medication.
  • Be as specific as possible in describing the events, and include a list of any witnesses with first-hand observations and knowledge of the incident(s). Any second-hand observations must be input in quotation marks, and it must be noted whether it comes from a colleague, visitor, or patient. Please clearly identify this source. If the witness is willing to be contacted, please include a phone number. 
  • It’s equally important to know what does not belong in an incident report: primarily opinions, finger-pointing, and conjecture. Do not offer a prognosis, speculate about who may have caused the incident, draw conclusions or make assumptions about how the event unfolded, or suggest ways that similar occurrences could be prevented. 
  • If a patient is involved, keep in mind that entering your observations in the HCP’s notes section of the patient’s chart does not take the place of completing an incident report, and filling out an incident report is not a substitute for proper documentation in the medical record.
  • Record clinical observations in the chart, not in the incident report, and make no mention of the incident report in the patient record. The report is a risk management and administrative document and not part of the patient’s record.
  • Please do not include patient data in your submitted incident report to Clipboard Health to protect the patient’s privacy in accordance with HIPAA. 

All complaint information submitted is kept confidential throughout the entire process of the investigation. Every effort is made to protect the identity of patients during the entire process of the investigation, and records have all identifying information changed to allow anonymity.

How to File a Report

Please complete our Incident Report Questionnaire, found here, within 48 hours of the incident in question. 

We look forward to receiving your response and taking care of this in a prompt manner.  You may contact our 24/7 support team if you have any questions via email at or by phone at 408-837-0116.

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