Incident Report · Thrive Therapy of Kansas

If anyone is in danger right now, call 911 first. Then complete this report as soon as you can.

This report is private and goes only to Thrive's leadership team. Fill in what you know. It takes about 5 minutes.

1 About you

Your full name

Your job

Your email (for your receipt and follow-up questions)

Your phone (optional)

Your area

2 Who was involved

Did this involve a client?

Yes No (for example, only an employee or a vehicle)

Client first name

Client last name

3 When and where

When did it happen? (best guess is fine)

When did you find out about it?

Where did it happen?

Were you or other Thrive staff with the client when it happened?

4 What happened? Check all that apply

5 Tell us in your own words

What happened? Include who, what, and what you saw or heard. What did you do right after? (optional) Who else was there or saw it? (names, optional) Who have you told so far?

6 Photos or documents Optional

Photos of damage or the scene, or any paperwork. Up to 25 MB each.

7 Confirm and send

This report is true and complete to the best of my knowledge. Type your full name as your signature