Employee Safety Report

This form is used to report adverse events experienced by healthcare workers — physical, psychosocial, biological, chemical, and radiological — using the HGHSS™ standard.

CGS Code

Generated automatically based on your selections

Institution Where Event Occurred *

Institution Type *

Unit/Location Where Event Occurred *

Job Category of Affected Employee *

Job Detail *

Occurrence/Harm Status of Event *

Duration of Impact *

Time Period When Event Occurred/Started

Adverse Event

Adverse Event Detail

Error Causing the Event *

Adverse Event Notification *

Done Not Done

Work Accident Notification *

Done Not Done

Gz1 durumunda otomatik olarak "Yapılmadı" seçilir.

Legal Action *

Initiated Not Initiated

White Code Process *

Initiated Not Initiated

Gz1 durumunda otomatik olarak "Başlatılmadı" seçilir.

Primary Cause of Event *

The options mainly cover areas related to improvement for institutions or employees. Causes originating from patients or patient relatives are not included. For events caused by multiple reasons, please select the option you consider most primary.

Date of Event *

(If unknown, leave the same as notification date.)

Notification Date

İşlemi tamamla butonuna tıkladığınızda bildiriminiz sisteme kaydedilecektir.

Employee Safety Report

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Employee Safety Report