Template

Mecklenburg Resident Falls RCA

by Brian Greig, from the Community

10+

This Resident Falls Root Cause Analysis template helps care teams investigate fall incidents in long-term care or health services settings. Document when and where the fall occurred, witness status, injuries and ER transfers, neuro checks, and precipitating events. Apply the Five Whys method to identify root causes, update care plans and fall risk scores, and assess whether interventions would have prevented the event. Use this tool to support quality assurance and patient safety improvements.

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With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Mecklenburg Resident Falls Root Cause Analysis
This Resident Falls Root Cause Analysis (RCA) template supports healthcare and aged-care teams in investigating a resident fall from end to end. Capture when and where the fall occurred, whether it was witnessed, and complete initial neuro checks per policy. Document injuries, ER transfers, and upload records. Use the Five Whys to uncover contributing factors, identify up to three root causes, and list targeted interventions. Update care plans and fall risk scores, then validate whether removing each root cause would have prevented the event. Includes references to CMS Five Whys guidance.
by Shellie Moore, from the Community
Downloads: 0
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Template
Monthly Falls Assessments
Use this monthly falls assessment template to systematically record and review falls each month. Capture where and when incidents occurred, the number of events, injury types, and whether safeguarding actions were required. Identify patterns by location and time of day, support root-cause analysis, and prioritize corrective actions to reduce future risk. Ideal for hospitals, aged care and residential facilities, this checklist helps teams monitor trends, document evidence for audits, and improve patient safety and quality of care. Customize to match your procedures and local requirements.
by Audit File, from the Community
Downloads: 10+
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Template
Root Cause Analysis (RCA) Report Template
Use this Root Cause Analysis (RCA) report template to investigate complaints and non-conformities, classify defects, and attach photos or video evidence. Document details like SKU, PO or batch references, and affected quantities. Analyze causes with fishbone categories (man, material, machine, method) and 5 Whys to identify the basic root cause. Plan containment, corrective, and preventive actions with owners, timelines, and status tracking. Update SOPs, work instructions, and training as needed, confirm team involvement, and validate completion with quality and production leaders. Ideal for manufacturing quality management and CAPA workflows.
by Randall Young, from the Community
Downloads: 10+
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Template
Resident Feedback Survey
This resident feedback survey template helps hospitals and care facilities measure patient and resident satisfaction after a stay. It captures an overall rating of the experience, likelihood to return for future health needs, a recommendation question, and how quickly concerns were resolved. Use it to uncover issues, document comments, and guide improvements in care quality and service delivery across wards, clinics, and long term care units.
by Nicole Admin, from the Community
Downloads: 0
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Mecklenburg Resident Falls Root Cause Analysis

This Resident Falls Root Cause Analysis (RCA) template supports healthcare and aged-care teams in investigating a resident fall from end to end. Capture when and where the fall occurred, whether it was witnessed, and complete initial neuro checks per policy. Document injuries, ER transfers, and upload records. Use the Five Whys to uncover contributing factors, identify up to three root causes, and list targeted interventions. Update care plans and fall risk scores, then validate whether removing each root cause would have prevented the event. Includes references to CMS Five Whys guidance.

by Shellie Moore, from the Community

Get

Template

Monthly Falls Assessments

Use this monthly falls assessment template to systematically record and review falls each month. Capture where and when incidents occurred, the number of events, injury types, and whether safeguarding actions were required. Identify patterns by location and time of day, support root-cause analysis, and prioritize corrective actions to reduce future risk. Ideal for hospitals, aged care and residential facilities, this checklist helps teams monitor trends, document evidence for audits, and improve patient safety and quality of care. Customize to match your procedures and local requirements.

by Audit File, from the Community

10+

Get

Template

Root Cause Analysis (RCA) Report Template

Use this Root Cause Analysis (RCA) report template to investigate complaints and non-conformities, classify defects, and attach photos or video evidence. Document details like SKU, PO or batch references, and affected quantities. Analyze causes with fishbone categories (man, material, machine, method) and 5 Whys to identify the basic root cause. Plan containment, corrective, and preventive actions with owners, timelines, and status tracking. Update SOPs, work instructions, and training as needed, confirm team involvement, and validate completion with quality and production leaders. Ideal for manufacturing quality management and CAPA workflows.

by Randall Young, from the Community

10+

Get

Template

Resident Feedback Survey

This resident feedback survey template helps hospitals and care facilities measure patient and resident satisfaction after a stay. It captures an overall rating of the experience, likelihood to return for future health needs, a recommendation question, and how quickly concerns were resolved. Use it to uncover issues, document comments, and guide improvements in care quality and service delivery across wards, clinics, and long term care units.

by Nicole Admin, from the Community

Get

Mecklenburg Resident Falls RCA

About author

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Mecklenburg Resident Falls Root Cause Analysis

Monthly Falls Assessments

Root Cause Analysis (RCA) Report Template

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You might also like

Mecklenburg Resident Falls Root Cause Analysis

Monthly Falls Assessments

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Resident Feedback Survey