Medication incident worksheet — Ontario’s fifteen fields
The College’s AIMS Incident Management Platform Criteria for Pharmacies lists fifteen data fields a platform has to capture. This is all fifteen, on one screen, free and with no account — 14 answered by whoever saw it and 1 added by the Designated Manager on review.
There is no submit button and no server. What you type stays in this browser tab and is gone when you close it — not stored on your computer either.
There is no field for a name, a date of birth, a health number or an Rx number. Field 3 is an age range, which is what the criteria document asks for.
Print it, or copy it and paste it into CPhIR, Pharmapod, TPSC Cloud — whichever one your pharmacy has selected.
What this is not
This worksheet is a capture aid. It is not a medication incident reporting platform, it records nothing, and it submits nothing to the National Incident Data Repository. Using it does not satisfy any part of the AIMS Program.
From January 1, 2027, every Ontario pharmacy must have selected and onboarded a medication incident reporting platform that can contribute to the National Incident Data Repository. That is true whoever you buy from, and it is not what this page is.
NarcCount is not yet able to submit data to the NIDR. Submission requires a Data Submission Protocol Agreement with ISMP Canada and successful API testing, neither of which is complete. Until then, NarcCount cannot be used to meet the NIDR submission requirement of OCP's AIMS Program. The Ontario College of Pharmacists does not approve or endorse incident management platforms.
Source: OCP — Timelines for changes to the AIMS Program (last updated November 3, 2025) — read 2026-09-06.
What the person who saw it records
Thirteen of the fifteen. None of them asks who you are.
What happened, in your own words. Do not include the patient's name, address, phone number, health number or Rx number.
Leave blank if it is not known.
A role, never a person's name.
Everywhere the incident touched. More than one is normal.
Drug, strength and DIN if you have it. No patient identifiers.
What the pharmacy changed, or is changing, because of this.
What the Designated Manager adds on review
Fields 14 and 15 are analysis rather than observation, which is where the Standard puts them — and keeping them separate is what lets the report itself stay anonymous.
The Designated Manager's analysis, not the reporter's.
Take it away
Print it for the file, or copy it and paste it straight into whichever platform your pharmacy has selected. 15 of the fifteen are still blank: #13, #1, #2, #6, #5, #8, #9, #10, #3, #4, #7, #11, #12, #14, #15.
The CSV is escaped so a description that begins with a dash or an equals sign cannot run as a spreadsheet formula — '=1+1 rather than =1+1.
Medication incident worksheet
Medication incident — it reached the patient
Prepared September 16, 2026 at 3:53 p.m.
Reported
| 13. Incident description | Not recorded |
|---|---|
| 1. Date incident occurred | Not recorded |
| 2. Time incident occurred | Not recorded |
| 6. Incident discovered by | Not recorded |
| 5. Type of incident | Not recorded |
| 8. Medication system stages involved | Not recorded |
| 9. Medication(s) involved | Not recorded |
| 10. Route of administration | Not recorded |
| 3. Patient age range | Not recorded |
| 4. Patient gender | Not recorded |
| 7. Medication prescribed by | Not recorded |
| 11. Associated factors | Not recorded |
| 12. Degree of harm | Not recorded |
| 15. Actions taken at pharmacy level | Not recorded |
Added on review
| 14. Contributing factors | Not recorded |
|---|
This worksheet is a capture aid. It is not a medication incident reporting platform, and nothing on it has been submitted to the National Incident Data Repository. Enter this record in the platform your pharmacy has selected.
Where to go from here
- What the AIMS rules actually say — the fifteen fields, the platform criteria, the data sharing agreement and the safety self-assessment, quoted with sources.
- The Designated Manager checklist — what has to be in place, and in what order.
- NarcCount’s AIMS module is free — the same fifteen fields with an incident register, causal-factor analysis, CQI records and unique logins behind them. What is included, what is not, and why.