Last Updated:
December 18, 2023

Vaccine Incident Reporting Form

A vaccine incident reporting form to gather and document information required when an error or incident occurs.

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Overview

All incidents/errors/near misses should be reported to your manager/organisation, and a local incident review should be undertaken to help understand what happened and how it can best be prevented in future.

Full information on the incident should be shared with your IMAC Regional Advisor and Immunisation Coordinator. All reports will be treated in confidence, but if preferred identifying information can be removed. Clinical advice can be provided by calling 0800 IMMUNE (0800 466863).

This form gathers all the necessary information to ensure appropriate and timely advice can be provided. The NIP incident notification template can be used, or if your organisation has a similar form that will be acceptable for IMAC purposes as well.



Cartoon image of a man showing his arm where he received a vaccination

Overview

All incidents/errors/near misses should be reported to your manager/organisation, and a local incident review should be undertaken to help understand what happened and how it can best be prevented in future.

Full information on the incident should be shared with your IMAC Regional Advisor and Immunisation Coordinator. All reports will be treated in confidence, but if preferred identifying information can be removed. Clinical advice can be provided by calling 0800 IMMUNE (0800 466863).

This form gathers all the necessary information to ensure appropriate and timely advice can be provided. The NIP incident notification template can be used, or if your organisation has a similar form that will be acceptable for IMAC purposes as well.

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Last updated:
Dec 2023