Please provide as many details as possible, including the date, time, and location; identities of victims; responsible individuals; and witnesses (if known) to help us investigate the incident.

This form is anonymous. While we’ll investigate to the best of our ability, limited actions may occur without further follow-up. We recommend identifying yourself for easier follow-up and response to your questions.

By submitting this form, I agree to allow the Healthcare Products Collaborative to store my entry. If contact details are provided, I consent to receiving communications from the Collaborative related to this report, yet I can OPT OUT at anytime by contacting www.healthcareproducts.org/contact. I also hearby understand and agree to the privacy policy provided here.