1. Cover Slide – have this up on the screen before presentation begins

2. of Incident Reporting at
The What & How
of Incident Reporting at
JASA

3. What Should Be Reported?
All Critical Incidents should be reported
Examples of Critical Incidents:
1. Abuse
2. Exploitation
3. Neglect
4. Serious Injury
5. Accidents
6. Missing Person
7. Death
8. Medical or Psychiatric Emergency
9. Law Enforcement Contact (Includes Calls to 911)
10. Suicide Attempt
11. Crime
12. Threats of Violence
13. Vehicle Accidents
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

4. Other Reportable Incidents
There are many other reportable incidents that are not critical incidents, such as damage to JASA property, slips, trips, falls and injuries suffered by JASA clients and staff, incidents where clients or staff become ill and 911 is called, anytime a crime occurs at a JASA facility or during the provision of services that involves our clients or staff and many more than can be listed here. They all need to be reported in the same manner.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

5. Definitions
1. Abuse
Willful use of offensive, abusive, or demeaning language by staff  that causes mental anguish.
Knowing, reckless, or intentional acts or failures to act by JASA staff which cause injury or death to a JASA client or placed that person at risk of injury or death.
Rape or sexual assault of a JASA client by a staff member.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

6. Definitions
2. Exploitation
An act committed by a staff member against a JASA client such as:
The taking or misuse of property or resources of a person we serve by means of undue influence, breach of fiduciary relationship, deception, harassment, criminal coercion, theft, or other unlawful or improper means;
The use of the services of a person we serve without just compensation; or
The use of a person we serve for the entertainment or sexual gratification of others under circumstances that cause degradation, humiliation, or mental anguish to the person we serve.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

7. Definitions
3. Neglect  
Negligent act or omission by a JASA employee which causes injury or death to a person we serve or which places that person at risk of injury or death.
4. Serious Injury or illness
That occurs while participating in or working for a JASA program or on JASA premises. 911 should be called with or without the permission of the client, staff or visitor.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

8. Definitions
5. Accident 
If a client, staff member or visitor is involved in or affected by any of the following scenarios:
Car accident with or without injuries in a JASA vehicle.
A fall on JASA premises or while participating in a JASA Program.
Fire-related incident on JASA premises.
Coming in contact with hazardous chemicals on JASA premises.
Injury due to structural defect on JASA premises or at a JASA program.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

9. Definitions 6. Missing Clients
Whenever there is police contact, that was initiated or received by JASA staff, regarding a missing client.
A missing person who is of concern is a JASA client who is known or suspected to be at risk due to health and/or safety issues.
A report should be made if JASA is responsible for supervision of a client and they go missing.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

10. Definitions
7. Death  
The death of an individual is reported if it occurred during a period of time in which they were attending a JASA program or a JASA provider is responsible for supervision of the individual.
A death should also be reported if the cause is unknown or suspicious in nature and JASA staff was in a role of ensuring their wellbeing or safety based on program guidelines.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

11. Definitions 8. Medical & Psychiatric Emergency
Admission of an individual to a hospital or psychiatric facility or the provision of emergency medical services (treatment by EMS) that results in medical care which is unanticipated and/or unscheduled for the individual while they are at a JASA program or receiving a JASA service.
Examples:
Emergency Medical Services (emergency room visit, first aid by EMS or JASA staff)
Emergency Psychiatric Services (*mental health facility admission or evaluation)
Life Saving Intervention (Heimlich, CPR)
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

12. Definitions 9. Law Enforcement Contact
Anytime that the police are called or arrive to a JASA facility or program an incident report must be submitted.
10. Suicide Attempt
A JASA client attempts or commits suicide.
Anyone else who may attempt or commit suicide on our premises.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

13. Definitions
11. Crime
A JASA client or JASA staff member attempts or commits homicide.
A JASA client assaults another JASA client, staff member or person in the community during program participation or is assaulted by another program participant, JASA staff or member of the community while participating in a JASA program.
Theft of personal or JASA property that was taken from JASA premises or a client’s home.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

14. Definitions 12. Threats of Violence
A report should be made if a JASA client or employee makes a threat of violence against another individual or facility in the community or makes a threat against JASA staff or JASA facilities.
13. JASA Vehicle Accidents
Any time a JASA vehicle is involved in an accident (while moving or parked).
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

15. How to report an incident
Procedure for Reporting an incident:
Ensure the safety of clients, staff and visitors
Notify your supervisor
Complete the JASA  incident report and submit the report within 24 hours to central office. Supervisors should ensure that all required reporting has been completed to funders/ oversight agencies.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

16. How to report an incident
All (DFTA & JASA) Incident Report Forms must be completed and sent to JASA Headquarters within 24 hours from the date of the incident/accident.
Any requested information not available at the time of submission of this report must be submitted in writing as soon as it is available. (police reports, doctor’s notes, etc…)
Please or share (on the Google Drive) incident reports to/ with and include if an employee was involved in the incident.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

17. How to report an incident
If you cannot scan/ or use the Google drive, faxes can be sent to
Please make sure you include any photos, statements, police reports, medical documentation, etc... that are important to reporting the full scope of the incident.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

18. How to report an incident
For incident reports that need to be submitted to DFTA please make certain that the district director and Elaine Rockoff are copied and made aware that the report is pending approval for submission to DFTA. Elaine will reply back letting you know if the report is ready for submission to DFTA or if additional information/ edits are needed.
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

19. How to report an incident
Please type and all incident reports or use the Google Drive. In order to type into the incident report on the Google Drive:
1) Make a Copy of the incident report (Never type into the original). To make a copy click on File and select Make a Copy
2) Once the copy is open click on File and select Rename
3) Rename it (Name of Program and the Date is a good title)
4) Type in the information
5) Add any statements, photos, police reports, etc...
6) Share with your supervisor, district director or program director, Carly Borenkind, Sydney Gorelick (HR Department if staff members were involved in the incident).
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)

20. How to report an incident
There are 2 incident reporting forms:
The DFTA Incident Reporting form
The JASA Incident Reporting form
They can be found on the Google Drive: NdvS7GYUJtYUcxSWllVkE?usp=sharing
Make sure for every additional slide you add put the JASA logo in the same place (Simply just copy and paste it in the same spot for each slide…or just copy and paste the sample slides)