Download Incident Report – paper substitute if ALR Dynamics unavailable – v04 July 5 2019 (pdf).
Print out this PDF file to report incidents, if the new system ALR Dynamics is unavailable for any reason. This updated form reflects the updated Incident Report attributes as of June 2019.
When your Dynamics reporting challenge is resolved, the incident must be submitted electronically ASAP. The narrative must state that the report was previously filed via fax along with a copy of the prior faxed report.
Follow the instructions in top right of form:
- Fax the paper Incident Report to (617) 222-7461. No voicemail notification of a paper submission is required. Note: All incidents reported via paper forms must be added later to ALR Dynamics, once access is available to an authorized user.
Note that the ALR QuickBase system should NOT be used after 12:01am Friday June 28, 2019.
Individual Incident Reports: use page (1). Check the Incident Type, and then circle the related Detailed Type. Describe the incident in the Narrative, provide all responses, and sign.
Facility-wide Incident Reports: Use Page (2). Answer the 5 required questions regarding the incident's impact, describe the incident in the narrative, provide all responses, and sign.
