Incident Report

Reference Guide

2010

Prepared by the State of Utah, Division of Juvenile Justice Services

Office of Internal Investigations

Revised October22, 2009

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INTRODUCTION

Critical incidents occur within all programs and facilities under the direction of the Division of Juvenile Justice Services (DJJS). These events range from situations as simple as “information only” to others, which may require referrals to the respective county attorney’s office or law enforcement.

These non-routine, unusual or potentially threatening circumstances require proper documentation. This documentation is accomplished by the preparation of Incident Reports.

This Reference Guide will explain:

When to prepare an Incident Report

Who should prepare an Incident Report

How to prepare an Incident Report

Who should be notified of an incident

How Incident Reports are distributed

Associate Program Director (APD) notification

Overall incident Summary Log for each facility/program distribution

How the Juvenile Court or entities other than DJJS are notified and/or distributed Incident Reports

In the event you require an internal investigation contact any of the following investigators:

Tara Jorgenson - Director

Office of Internal Investigations

OgdenRegionalCenter
2540 Washington Blvd Basement Rm.#26
Ogden, Utah84401
(801) 514-2632 Cell
(801) 626-3407 /
Jantz Afuvai

Internal Investigator

(801) 626-3397 Office
(801) 514-2353 Cell
(801) 626-3407 Fax
/
Dustin Howard

Internal Investigator

(801) 626-3396 Office
(801 514-0728 Cell
(801) 626-3407 Fax

DIRECTIONS FOR COMPLETING INCIDENT REPORTS

An Incident Report shall be generated by staff to account for any non-routine, unusual, or potentially threatening event or incident that occurs. The report shall be prepared generally by staff, but may be used by any person having direct involvement in or knowledge of an incident. When multiple staff respond to or have knowledge of an incident a lead person shall be designated to generate an Incident Report per incident episode. All others shall generate Supplemental Reports describing their involvement during and immediately after an incident. An incident episode generally refers to the length of an incident at onset until the incident has been dealt with or resolved.

In the event that an Incident or Supplemental Report has been signed and submitted and the writer remembers or learns that additional information is needed or requested in writing, then staff shall generate an Addendum Report. An Addendum Report shall be written using the Supplemental Report format and its writer shall indicate in the Description of Incident portion of the report that this report is an addendum to my original Incident (or Supplemental) Report, while referring to the original Incident (or Supplemental) Report number.

All reports are considered to have been submitted after its writer has either signed the report; or has sent the report via courier, fax, mail, or email (regardless of whether the report is signed). Once a report has been submitted it is considered complete and will be used as an official document accounting for the incident. Once reports have been submitted they shall not be altered, modified, or amended. An Addendum Report however, may be used to document additional information.

Incident, Supplemental, and Addendum Reports should be limited to factual, concise, and objective information that accounts for what its writer did during and immediately after the incident.

  1. WHEN TO PREPARE AN INCIDENT REPORT.

Incident Reports should be used to describe any non-routine, unusual, or potentially threatening event in a DJJS facility or program, or contracted private provider when the event involves DJJS. Events requiring completion of an incident report include, but are not limited to: accidents, suicide attempts, assaults, physical interventions, absconded youth, or any other non-routine, unusual, or potentially threatening occurrences. Reports shall be completed before the end of the shift when the incident occurred, or within 24 hours when approved by a supervisor. Incident Report forms do not replace other required documentation (e.g. disciplinary and/or progress notes).

  1. WHO SHOULD PREPARE AN INCIDENT REPORT.

Employees of the Division of Juvenile Justice Services, Private Providers contracted with the Division, and any other person(s) having legitimate business with any youth under Division care shall prepare a report when incidents occur. Any person(s) involved in or directly aware of an incident shall complete an Incident or Supplemental Report. A person who may not have witnessed an incident, but may have received information about an incident may also generate an Incident Report. There should only be one Incident Report per incident episode. All other reports accounting for an incident shall be written in a Supplemental Report format.

  1. WHO SHOULD PREPARE A SUPPLEMENTAL REPORT.

Supplemental Reports are completed by staff (or witnesses) when more than one staff responds to or is aware of an incident. One staff shall be appointed to generate an Incident Report and all others shall generate Supplemental Reports. Again, there should only be one Incident Report per incident episode.

  1. PREPARATION OF AN INCIDENT REPORT.

When preparing an Incident or Supplemental Report, all applicable portions of the Report shall be completed. The following is a description of what information needs to be included in each portion of the report:

  1. Juveniles Involved: The names of all the juveniles involved should be listed including their case number when available (Case # Last, First, Middle Name).
  1. Date, Time & Incident Location: The date and time should reflect when the incident occurred and not when the report was generated or completed. The location of the incident should describe specifically where the incident occurred. For example: If an incident occurred at the Mill Creek Youth Center (MCYC), then the location should clarify specifically where in the MCYC the incident occurred, e.g. Cottage W, Room 1.
  1. Staff on Shift and Witnesses: The person preparing the report should list names of staff members on shift who were involved in or have knowledge of the incident. Witnesses include other youth, volunteers, school staff, or any person(s) who witnessed the event.
  1. Description of the Incident (Section A): The most critical portion of the report!

Information contained here should define who is preparing the report (name and job title). All reports should be written in first person (for example: I, John Doe, JJS Counselor II…). The information written should be clear, concise, accurate, specific and as detailed as possible. The writer should always strive to report objectively, factually, and as accurately as possible. Subjective and judgmental statements should be avoided.

When incidents result in physical intervention by way of control holds and/or mechanical restraints, the writer should document specifically which control holds were used, who applied the restraints, and how long the holds and/or restraints were used. The writer should also document any verbal de-escalation techniques that were used as well as their justification for using force in line with Division policy. Again, clear, concise, specific, accurate, and detailed information are the most important elements of this section.

  1. Use of Force (Section B): Anytime force is used by staff during an incident, all staff involved shall use the check boxes to identify their justification to use force as governed by Division policy. Each staff shall also identify and document the control hold (by name) that was attempted or applied to the youth. If the use of force resulted in an injury (e.g. rug burn, bloody nose, etc.) to youth or staff then the injury shall be documented in this section as well. The writer shall identify who was injured, what was done about the injury, and whether medical attention was required. Anytime medical attention is required, the person writing the report will identify the medical personnel (by name) and the date that the person received the medical attention.
  1. Injury Accounting (Section C): Anytime an injury is observed or occurs then staff shall document the injury and report it to their supervisor, medical personnel, or emergency services depending on its severity. When an injury occurs as a result of an incident (excluding injuries already accounted for during a use of force type of incident covered in Section B) then this section is to be used to account for when the injury was observed, how the injury was sustained, and what was done about the injury.
  1. Action Taken (Section D): The person who has prepared the report should list what immediate action was taken or any further recommendations they deemed appropriate. This section should also indicate who was informed of the incident, e.g. the supervisor (by name) notified.
  1. Attachments: In this section, the writer indicates that additional information is included with the Incident Report. This additional information may include one or more of the following:
  1. Supplemental Report: This checkbox is marked in the event a Supplemental Report has been prepared. Include the number of Supplemental Reports completed.
  2. Evidence. This check box is marked if some form of evidence has been collected. This includes contraband, weapon, illegal substance, etc.
  3. Diagram. This checkbox is marked when a diagram has been provided as an attachment to the initial Incident Report, describing an area or something significant about the incident.
  4. Surveillance Camera. This checkbox is marked when the incident occurred within the view of a facility/program surveillance camera.
  5. Other. This checkbox is marked when any other attachments not previously clarified are necessary. For example: photographs, letters, drawings/writings, etc.
  1. Check Boxes: In this section, the writer indicates all boxes that apply to the incident.
  1. Classification. The writer identifies the type of incident and the Level (1-4) of severity of the incident that took place.
  1. Incident #: In order to provide for more efficient accounting of incident reports, a number should be assigned to each report generated. This number is to be assigned by secretarial or other designated office staff.
  1. NOTIFICATION OF INCIDENT: All incidents (Level’s 1-4) shall be reported within twenty-four (24) hours of occurrence. Depending upon the incident’s severity (Level 1-4), notification of an incident shall follow a Chain of Command as outlined near the end of this reference guide. All parties within the Chain of Command, as dictated by the incident’s severity, shall be notified as well. All Level 1 notifications shall be handled in the following manner: Notification shall be done immediately by phone with a live person. A voicemail message is not sufficient as notification for a Level 1 incident. The person who is attempting to make contact with someone on the Chain of Command shall start with their immediate supervisor and then proceed upward from there. Private Providers shall contact the youth’s Case Manager first; if unsuccessful the Private Provider shall contact an Investigator from the DJJS. Once a live person has been contacted it is the responsibility of that contacted person to notify the next person/party in the Chain of Command. All incident notification attempts and contacts shall be documented in the Action Taken portion of an Incident or Supplement Report.
  1. DISTRIBUTION OF INCIDENT REPORT. An Incident or Supplemental Report(s) shall be distributed to all parties listed under the Chain of Command as based on the severity of the incident. Distribution may be done through email, fax, courier, or mail depending on the situation (contact an Investigator if unsure). The original Incident and Supplemental Report(s) shall be kept and maintained indefinitely by the sending facility or program. The facility or program administration shall store all original reports. Copies of the original Incident and Supplement Reports shall be sent to the youth’s Case Manager when the incident involves a DJJS youth. When the incident did not involve, implicate, or influence a DJJS youth, rather a staff on staff issue, etc. copies of the original reports shall be sent to the appropriate party(s) within the Chain of Command (this mainly applies to DJJS employees).
  1. ASSOCIATE PROGRAM DIRECTOR NOTIFICATION. (This only applies to DJJS) All unusual incidents that endanger the lives or physical welfare of the youth or staff shall be reported to the Associate Program Director or designee, immediately. Examples of these types of incidents include, but are not limited to:
  • Death
  • Attempted suicide when hospitalization occurs
  • Fire, when serious bodily harm or significant building damage is done
  • Riot
  • Any assault on youth by a staff member
  • Sexual assaults, relations or indecent liberty
  • An escape from a correctional facility
  1. DISTRIBUTION OF INCIDENT REPORT SUMMARY LOG: Facilities or programs shall fax or email a copy of the Incident Report Summary Log to the Office of Research Evaluation & Planning (REP) representative quarterly.
  1. JUVENILE COURT OR ENTITY OTHER THAN DJJS NOTIFICATION / DISTRIBUTION: Notification that an incident occurred and the distribution of any reports generated by DJJS to agencies or entities other than DJJS shall be dealt with by the principal DJJS administrator where the incident occurred. Copy(s) of Incident or Supplemental Report(s) may be forwarded to agencies or entities other than DJJS only after the principal DJJS administrator has deemed it necessary for release. The principal DJJS administrator may notify other agencies or entities of incidents that occur when the incident pertains to the function of the other agency or entity. Incident and Supplemental Reports are classified as “private” under the Governmental Records Access Management Act (GRAMA, UCA 62-3-204). Incident and Supplemental Report(s) that are collected during the course of an Internal Investigation become “protected” under GRAMA. In the event that Incident and Supplemental Reports are deemed necessary for release to law enforcement or a District or CountyAttorney’s Office, please contact an Investigator or The Office of Quality Assurance for further release information.

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INCIDENT REPORT LEVELS OF SEVERITY

The Level of Severity system identifies the severity of the incident that occurs within the facility/program.

The system is comprised of four levels of severity:

Level 1Maximum severity

Level 2Intermediate severity

Level 3Minimum severity

Level 4Information only

As indicated, the classification of incident reports delineates from the most severe to the least severe.

Directions for completing Incident and Supplemental Reports have been distributed to all programs and facilities throughout the DJJS and to all contracted private providers. The Incident Report Reference Guide is also accessible through the policy and procedure section of the DJJS website.

As a reminder, all Incident and Supplemental Reports shall be completed before the end of the employee’s shift when the incident occurred, or within twenty-four (24) hours when approved by a supervisor.

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INCIDENT REPORT LEVELS OF SEVERITY

LEVEL 1 – MAXIMUM SEVERITY

ACCIDENT

  • Where the injury requires immediate treatment from a medical professional or hospital.

AGGRAVATED ASSAULT

  • Assault with an object and serious bodily injury occur(s).

ARSON

ANY CRISIS EMERGENCY RESPONSE INVOLVEMENT FROM AN AGENCY/ENTITY OUTSIDE THE DIVISION

  • When an incident requires that a crisis emergency response type of agency/entity is contacted or dispatched to take tactical command over the incident. A crisis emergency response type of agency/entity includes, but is not limited to: Law Enforcement, Fire Department, Centers for Disease Control (CDC), etc.

ANY SERIOUS BODILY INJURY OCCURS

  • Means any bodily injury that creates or causes serious permanent disfigurement, protracted (prolonged or extended) loss, or impairment of the function of any bodily member, or organ, or creates a substantial risk of death;
  • Whether intentionally or not.

ESCAPE

  • By prisoner from a secure facility or detention center.

ILLNESS

  • Where the illness requires immediate treatment from a medical professional or hospital.

OFFICIAL MISCONDUCT BY STAFF

  • Any illicit drug activity by staff, youth, school employee, private provider or other;
  • Any Code of Ethics or Policy Procedure violations that endanger the lives or physical welfare of staff or youth.

OTHER

PROPERTY DAMAGE

  • With discretion, damage to a DJJS facility may result in 3rd Degree Felony charges consistent §76-8-418; or the value of the property is or exceeds $5,000.

RIOT

  • When two or more youth engage in tumultuous or violent conduct consistent with §76-9-101.

SUICIDE – COMPLETED

UNATTENDED OR ATTENDED DEATH

UNLAWFUL SEXUAL ACTIVITY WITH A YOUTH IN CUSTODY

  • Custodial Sexual Relations
  • Custodial Sexual Misconduct – Indecent Liberties

WEAPONS RELATED OFFENSES BY RESTRICTED PERSONS, OR ANY FIREARM RELATED OFFENSE

  • Category I Restricted Persons
  • Any Parolee;
  • Any youth convicted of a violent felony as defined in § 76-3-203.5;
  • Remains Cat I Restricted Person for 10 years.
  • Category II Restricted Persons
  • Any youth convicted of any felony;
  • Remains Cat II Restricted Person for 7 years.

LEVEL 2 – INTERMEDIATE SEVERITY

ABSCONDED FROM PLACEMENT
  • Youth absconds from a community-based program (e.g. O&A, Genesis, proctor care, group home, etc.);
  • This only applies to adjudicated youth committed to DJJS for community placement.
ACCIDENT
  • Where the injury requires treatment within 24 to 48 hours from a medical professional.

AIDING A RIOT

ANY PHYSICAL INTERVENTION AND/OR RESTRAINT USED
  • Use of any physical intervention technique;
  • Use of any mechanical restraint or device used for the purpose of restricting movement;
  • Use of any chemical for the purpose of restraining a youth; or a chemical that could be perceived as being used for the purpose of restraining a youth;
  • DJJS justification for any physical intervention or restraint must be in compliance with Policy No. 05-07.

ANY SUBSTANTIAL BODILY INJURY OCCURS

  • Means bodily injury, not amounting to serious bodily injury, that creates or causes protracted (prolonged or extended) physical pain, temporary disfigurement, or temporary loss or impairment of the function of any bodily member or organ.
ASSAULT BY PRISONER WITH INJURY
  • An assault by any youth incarcerated in a DJJSDetentionCenter or Secure Facility on another person.
ATTEMPTED ESCAPE FROM A CORRECTION FACILITY
ASSAULT AND SUBSTANTIAL BODILY INJURY OCCURS
CODE OF ETHICS/POLICY PROCEDURE VIOLATIONS OR PROVIDER CODE OF CONDUCT VIOLATIONS
  • Where a staff is sanctioned and/or terminated as a result of the violation.
CRIMINAL MISCHIEF
Any person who intentionally and unlawfully tampers with property of another (or the State) and by doing so recklessly endangers human life or human health or safety or recklessly causes or threatens a substantial interruption or impairment of any critical infrastructure; to include communication systems (e.g. radios, computers, DVR’s).
ILLNESS - PROLONGED
When a person exhibits an illness over an extended period of time, has been seen by a medical professional and their health does not appear to improve.
LEWDNESS
  • A person who performs any of the following acts in public; or the person should have known that any of the following acts would likely be offensive, insulting or alarming:
  • Expose genitals, female breast (areola), buttocks, anus, or pubic area;
  • Masturbates.

MISCONDUCT REPEATED ACTIVITY