Incident Reporting Form For Adult Social Care Providers

Author: Luisa Squatriti, Contracts Officer, Sheffield City Council

Date Published: February 2022

Date to Review: February 2023


Completing an Incident Report Form

The Incident Report Form has been designed to capture information in relation to the performance of providers in Sheffield, including Care Homes. It should be completed to formally report any incidents identified. This will assist Sheffield City Council’s Quality & Performance Team (Commissioning, Adult Social Care) to build up a picture of a provider / care home and will enable informed decisions to be made in relation to identifying training needs and developing a monitoring plan to ensure quality of care. The Quality & Performance Team work in close partnership with Sheffield CCG’s Quality in Care Homes Team.

Please note that this Form does not replace the Safeguarding Adults Procedures or Serious Incident procedures, nor does it take away the responsibility of the individual professional to address issues with the care home manager initially.

If you identify or become aware of an incident or concern at a Residential or Nursing home you should first discuss this with the care home Manager or person on duty. This will enable the care home to start addressing the issues immediately.

Please complete an Incident Report Form and email it to the Quality & Performance Team

Email: (For internal use only)

The Incident Report Form will then be processed by the Quality & Performance team in line with the internal process. If the Form requires an investigation a copy will be sent to the home for a response.