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Medical Incident Reporting

- This page is intended for use by the Saint Jude staff and the volunteer members of our medical response team. Reporting medical incidents is important to the overall safety of the Parish. In this context, medical incidents include everything from an individual requiring basic first aid (i.e. minor cuts, bruises, minor burns, etc.) to potentially life-threatening situations that require outside medical assistance. Reporting such events is critical to allow internal safety reviews (when appropriate), to enable the review and improvement of our medical response procedures, and to track the usage of medical supplies and equipment. The response to medical emergency is part of the Saint Jude Emergency Operations Plan, maintained by the Security Ministry. The Security Ministry can be reached at [email protected] or by calling 973-398-6377, Option 8.
- Medical Incident Report
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Please report medical incidents that have occurred on Saint Jude property using the form below. This is a post-incident report intended to support our continuous quality improvement efforts and to track the usage of medical supplies and equipment. All reporting will remain confidential.
  
  Date of the medical incident REQUIRED Please fill out this field. Please enter a date.
  
  Time of Incident REQUIRED
  Approximate time of the medical incident
  Please fill out this field. Please enter valid data.
  
  Incident Location REQUIRED
  Where did the incident occur?
  Please fill out this field.
  
  What event was underway at the time of this incident? REQUIRED
  What was going on at the time of the medical incident?
  Please fill out this field.
  
  Were 9-1-1 Emergency Medical Services (EMS) Involved? REQUIRED
  Was 911 called to request medical support?
  Yes No Please fill out this field.
  
  Was this a Safety related incident? (if Yes, provided details below). REQUIRED
  A safety related medical incident means one that we might prevent in the future by changes to the facility or practices
  Yes No Please fill out this field.
  
  Description of Safety-related Concern
  
  Saint Jude Responder Actions REQUIRED
  Briefly describe the medical assistance rendered by the Saint Jude responder
  Please fill out this field.
  
  Feedback REQUIRED Please fill out this field.
  
  Your Contact Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email
  Enter your email address
  Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Submit
  
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St. Jude Parish

40 Maxim Dr. Hopatcong NJ 07843

Medical Incident Reporting

Medical Incident Report