Incident Report Debriefing Form

Mental health professionals are mandated by law to report abuse, neglect, suicidal or homicidal attempts, and sexual assault or abuse. Those situations require a Written Report for all of the situations above, Still Waters Professional Counseling, Inc. (SWPCI) requires any counselor or staff member who is aware of these situations to provide a Written Report of the Mandated Reporter and a Critical Incident Form. This form is to be used to perform a debriefing of what has transpired since the incident.

  • Important!

    The submission of this report does not take the place of your mandatory reporting capability. This form must be completed for any incident involving employees, consumers, and/or any other persons involved with employees or consumers, such as parents, siblings, or teachers.
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  • Incident Description:

    The incident this debriefing is referring to.
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  • Incident Debriefing:

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  • Person Making the original incident Report - Information

  • Person making the debriefing

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