1. (1) The facility superintendent or program director shall establish a review process for every Suicide Attempt or Serious Self-Inflicted Injury requiring hospitalization or medical attention and a mortality review for a completed suicide.

2. (2) The serious Suicide Attempt or Serious Self-Inflicted Injury review process and mortality review process shall be multidisciplinary, involving administrative, direct care, mental health and medical personnel and include a critical inquiry of the following:

   1. (a) The circumstances surrounding the incident;
   2. (b) Facility procedures relevant to the incident;
   3. (c) All relevant training received by involved staff;
   4. (d) Pertinent medical and mental health services involving the victim;
   5. (e) Possible precipitating factors leading to the Suicide Attempt, Serious Self-Inflicted Injury or completed suicide;
   6. (f) Recommendations, if any, for changes in policy, training, physical plant, medical or mental health services and/or operational procedures shall be made in writing.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.601(3)(a), 985.14(3)(a), 985.145(1), 985.18, 985.48(4), 985.64(2) FS. History–New 3-16-14.