- Affirmation Statement*
Completed by accredited organizations, ONLY when an Alternative 4 review in response to a sentinel event is chosen.
- Framework for Conducting a Root Cause Analysis and Action Plan*
A template to aid in organizing the steps in a root cause analysis and developing an action plan. A modified electronic version (Sentinel Event Root Cause Analysis Tool) is provided on accredited organizations’ extranet site when “Direct Submission” is chosen in response to a sentinel event.
- Root Cause Analysis Matrix**
Outlines detailed inquiry areas for more frequently reported types of events; does not include every event type.
- Self Report Form
An electronically submitted self-report form is now available on accredited organizations’ Joint Commission Connect extranet site in the Continuous Compliance Tools section. The paper form can be provided if necessary by calling the Sentinel Event Unit at 630/792-3700.
* Requires Microsoft Word
** Requires Adobe Reader