[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-242457-105":53,"doc-detail-242457-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","kleos-critical-incident-report-incident-reporting-form","Kleos Critical Incident Report - Incident Reporting Form","","Kleos Critical Incident Report provides a structured procedure for documenting critical incidents occurring during in-person and virtual learning or support sessions involving Kleos staff or contracted service providers. It captures key details such as involved team members, students, witnesses, incident type selection, timeline, location, first-person observations, actions taken, and staff debrief notes. The process also records notifications to parents/guardians, principals, and leadership, plus recommendations, responsible persons, deadlines, follow-ups, and review/initial confirmation, ensuring timely submission within the required timeframe.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/kleos-critical-incident-report-incident-reporting-form/242457/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/kleos-critical-incident-report-incident-reporting-form/242457.png","ImageObject",442,249,{"name":88,"@type":89},"Felix Montgomery","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-08","2026-09-12",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the purpose of the Kleos Critical Incident Report?","Question",{"text":108,"@type":109},"It is used to report critical incidents that occur during in-person and virtual sessions involving Kleos staff or contracted service providers.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Who must be notified and when?",{"text":113,"@type":109},"Parents/guardians and the Principal must be informed as soon as it is safe to do so, and no later than the end of the student program day; the Principal then informs the Kleos VP and Kleos Case Manager.",{"name":115,"@type":106,"acceptedAnswer":116},"What steps are required after documenting the incident?",{"text":117,"@type":109},"A debrief is recommended to plan prevention for similar incidents, notifications are recorded, recommendations are listed with responsible persons and deadlines, then the report is reviewed (initialed) and submitted as a PDF email attachment within 7 days.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},242457,1789190799,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":73},549768064778,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","KLEOS CRITICAL INCIDENT REPORT  \nPURPOSE: For reporting Critical Incidents that occur during in-person and virtual sessions with a Kleos Staff member or contracted Service Provider.  \nPROCESS: Staff Members and Service providers complete the Kleos Critical Incident Report and inform Kleos Service Provider and Kleos Principal of any critical incidents occurring during in-person and virtual learning/support sessions.  \nTeam Members Directly Involved:  \nStudents Directly Involved:  \nWitnesses (students, staff, volunteers, community members) :  \nType of incident: (choose all that apply)  \n  Violence (strike or grab) with intent to harm and/or causing injury requiring medical attention   Aggression resulting in substantial property damage or death threats  \n  Elopement, Wandering or Missing Child  \n  Possession or use of a weapon with attempt and/or intent to harm  \n  Self-harm serious enough to require medical attention or by means not previously documented   Suicidal ideation with expressed plan and available means or evidence of plan and means   Suicide attempt*  \n  Possession or use of illicit drugs  \n  Physical non-violent crisis intervention used (restraint)   Motor vehicle accident involving student  \n  Medical incident that involves student transfer to the hospital   Other:  \n*Ifa student describes an incident as a suicide attempt, it must be recorded as such, regardless of whether the means was lethal. Previous suicide attempt is one of the factors that increases risk of suicide completion.  \nDate: Duration of Incident:  \nTime: Location of Incident:  \nStaff Report of Incident:  \nDescribe first person observations of the incident; be concise; include time and quote when possible.  \n1. Team Member Name:  \nDescribe precipitating factors:  \nDescribe preceding events:  \nDescribe incident:  \nDescribe action taken:  \nSignature: Date:  \n2. Team Member Name:  \nDescribe preceding events:  \nDescribe incident:  \nDescribe action taken:  \nSignature: Date:  \nDebrief:  \nA team meeting to collaborate on ways to prevent similar incidents in the future is recommended. Record those in attendance and any discussion notes.  \nNotifications:  \nParents/guardians and Principal to be informed as soon as it is safe to do so, and no later than the end of the student program day. Principal to inform Kleos VP and Kleos Case Manager.  \n\n| Notification | Name | Date/Time | Method\u003Cbr>(in person, email, phone,virtual) |\n| --- | --- | --- | --- |\n| Kleos Principal |  |  |  |\n| Parent/guardian 1 |  |  |  |\n| Parent/guardian 2 |  |  |  |\n| Kleos Case Manager |  |  |  |\n| Kleos VP |  |  |  |\n\n\n| Kleos VP |  |  |  |\n| --- | --- | --- | --- |\n| Other |  |  |  |\n| Other |  |  |  |\n\nRecommendations to prevent similar incidents in future:  \nPrincipal or Vice Principal to complete recommendations within 3 working days.  \nRecommendation 1 :  \n●  \nPerson(s) responsible:  \nDeadline:  \nFollow up:●  \nRecommendation 2:  \nPerson(s) responsible:  \nDeadline:  \nFollow up:●  \nRecommendation 3:  \n●  \nPerson(s) responsible:  \nDeadline:  \nFollow up:●  \nRecommendation 4:  \n●  \nPerson(s) responsible:  \nDeadline:  \nFollow up:●  \nPrincipal: Signature: Date:  \nReview:  \nInitial to confirm you have reviewed this incident report and agree to follow the above recommendations.  \n\n| Name | Position | Date | Initials |\n| --- | --- | --- | --- |\n|  |  |  |  |\n\n\n|  |  |  |  |\n| --- | --- | --- | --- |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n\nSubmit:  \nSubmit CIR, including follow up, as a pdf email attachment within 7 days to the following parties: Kleos Principal, Kleos VP, Case Manager.","cbCaiqJWr0nii31q","https://ap.wps.com/l/cbCaiqJWr0nii31q","pdf",290331,"English","# Purpose\n# Process\n# Incident Details\n## Teams and Individuals Involved\n## Incident Type and Timeline\n## Staff Report Entries\n# Debrief and Notifications\n## Debrief\n## Notifications Log\n# Recommendations to Prevent Future Incidents\n## Recommendation Plan and Follow-up\n# Review and Submission","[{\"question\":\"What is the purpose of the Kleos Critical Incident Report?\",\"answer\":\"It is used to report critical incidents that occur during in-person and virtual sessions involving Kleos staff or contracted service providers.\"},{\"question\":\"Who must be notified and when?\",\"answer\":\"Parents/guardians and the Principal must be informed as soon as it is safe to do so, and no later than the end of the student program day; the Principal then informs the Kleos VP and Kleos Case Manager.\"},{\"question\":\"What steps are required after documenting the incident?\",\"answer\":\"A debrief is recommended to plan prevention for similar incidents, notifications are recorded, recommendations are listed with responsible persons and deadlines, then the report is reviewed (initialed) and submitted as a PDF email attachment within 7 days.\"}]","Kleos Critical Incident Report - Incident Reporting Form | PDF"]