(1) The Initial Incident Report shall include, but not be limited to, the following:

1. (a) the individual involved;
2. (b) provider(s) involved;
3. (c) date, time, and location of the incident, if known;
4. (d) the incident category;
5. (e) description of the incident;
6. (f) immediate action taken to protect health, safety and welfare;
7. (g) people involved in the incident including any eyewitnesses to the incident.

(2) The Final Incident Report shall include at least the following:

1. (a) additional action(s) to be taken;
2. (b) the responsible party(ies) and the target completion date(s) for action(s); and,
3. (c) the Initial Incident Report and any additional information gathered after filing of the Initial Incident Report.