Patient Safety Reporting System

Select textsizemediumlargelarger

Mandatory Reporting Instructions, Forms & Letters

All events and RCAs must be submitted through the web based reporting system.

New Jersey Department of Health
Patient Safety Reporting System
Office of Health Care Quality Assessment
225 E. State Street
2nd Floor East
Trenton, NJ 08625
Phone: (609) 633-7759
Fax: (609) 984-7707

These documents were created as part of the Department of Health’ implementation of the “Patient Safety Act,” P.L. 2004, c.9, (N.J.S.A. 26:2H-12.23-12.25) [pdf 19k] Rules (NJAC 8:42 E-10) implementing this act were published at 40 New Jersey Register 1094 (March 3, 2008). Patient Safety reporting began on February 1, 2005, for general hospitals. Psychiatric, Special and Comprehensive Rehabilitation hospitals began reporting on April 1, 2008 and Ambulatory Care Surgery Centers began reporting on October 1, 2008.

Patient Safety Memoranda

  • Memo [pdf 324k] from Patient Safety Reporting System, September 7, 2010 to all licensed health care facilities currently reporting to Patient Safety regarding Unstageable Pressure Ulcers.
  • Memo from the Commissioner, April 28, 2009 to all licensed assisted living residences, comprehensive personal care homes, assisted living programs, long term care facilities, residential health care facilities attached to another facility type regarding reporting adverse patient safety events effective May 1, 2009. Form available here.
  • Memo from the Commissioner, February 27, 2009 to all licensed home health care agencies, hospice care providers, and ambulatory care facilities regarding reporting adverse patient safety events effective April 10, 2009.

Patient Safety Instructions for Licensed Health Care Facilities

  • Guidance on Development of a Root Cause Analysis for Patient Safety Reporting, March 2008 [pdf 312k]
  • Mandatory Patient Safety Reporting Requirements for Licensed Health Care Facilities (instructions and forms), October 27, 2008 [pdf 307k]
  • ASC Guidance, September 9, 2009 [pdf 324k]

Consensus Definitions for the RCA Form: definitions developed to support the continual efforts to improve patient safety in your facility and to maintain consistency.