Definition: An incident is any adverse occurrence or event inconsistent with the College's routine operation.
Clinical Practicum: Any incident occurring in the clinical setting requires the student and faculty/supervisor to follow institutional policy regarding incident reporting.
Injury on Campus: Any incident occurring on the College campus involving injury requiring more than basic first aid shall be documented using the Maine College of Health Professions (MCHP) Incident Reporting form and will be reported via the CMMC incident reporting system at the discretion of the College President.
Where there is a minor injury needing no more than basic first aid, the college employee will complete the Maine College of Health Professions (MCHP) Incident Report form and forward the form to the President of the College.
When there is an injury or possible injury that would require or potentially require more than basic first aid):
- Emergency services (call 9-911) should be encouraged for all parties involved. If a visitor refuses to access emergency services, this refusal should be documented in the MCHP incident report.
- The college employee will ensure the MCHP Incident Report is completed as soon as possible after the incident.
The form must be sent to the President of the College, who will determine its dissemination.
Theft or Property Damage: Any event involving property damage or theft of personal items shall be documented and reported immediately using the College Incident Report Form. (Attached)
Contact CMMC Security immediately for any security concerns at 207-795-2299.
When there is theft, fire, property damage, etc.:
- Contact CMMC Security
- The College employee will call 9-911 in-house or 911 for other devices
- The College employee will contact the President of the College
- The College employee will complete the MCHP Incident Report Form within 24 hours of the occurrence
- The College employee will forward the completed form to the President of the College, who will determine its dissemination
- If there is physical harm to anyone involved, follow the procedure for Injury on Campus as described above.
*NOTE – In no instance should any statement relating to the College’s liability be made by an employee of the College, except as authorized by the President of the College.
Approved:______________________________________________________________________
Monika Bissell, DBA
President
Incident Report: Injury, Property Damage, Event
Date of Incident _______________________________
Time Incident Occurred: _______________________________
Location of Incident: _______________________________
If ‘Other’ was chosen name/describe/give address of location: _______________________________
Name of Person Involved in the Incident: _______________________________
Address:_______________________________
Phone:_______________________________Email:_______________________________
If more than one person was directly involved (not witnesses), enter their names, addresses, phone, and email
Injuries
Purpose of Injured person on/near campus property _______________________________
If ‘Other’ was chosen explain the purpose of the injured person’s presence on/near campus:_______________________________
Describe the incident in detail: _______________________________
Was first aid or medical attention given? _______________________________
If first aid or medical attention was given, who administered this? _______________________________
Was the injured a minor? _______________________________
If a minor, were parents or guardians notified? _______________________________
Name and contact information of parent or guardian contacted _______________________________
Property Damage
Describe the Property Damage: _______________________________
Extent of Damage: _______________________________
Were Police Notified?_______________________________
If so, which Police Department?_______________________________
Owner of Property: _______________________________
Address of Owner: _______________________________
Phone of Owner: _______________________________ Email of Owner: _______________________________
Other Event
Description of what occurred, and any action taken: _______________________________
Did police investigate and make a report? _______________________________
If so, which police department? _______________________________
Witnesses
Name, address, phone, and email of any witnesses: _______________________________
Person completing this report:
Name: _______________________________ Date of Report _______________________________
Phone:_______________________________ Employee Position: _______________________________
Division: _______________________________
Campus Information: To be completed by the Dean of Division or Senior Administrator
Completed by: _______________________________Date this section is complete: _______________________________
Was incident investigated by the College? _______________________________
If yes, include notes of investigation: _______________________________
Upload any photos that were taken:
Purpose of Report
The purpose of this report is: _______________________________
If the purpose is for a claim, will the claimant be contacted by the College?_______________________________