Medication incident worksheet — Ontario’s fifteen fields
The fifteen data fields in the College’s AIMS Incident Management Platform Criteria for Pharmacies, on one screen. Free, with no account.
No submit button, no server. What you type stays in this tab, is never saved, and is gone when you close it.
There is no field for a name, date of birth, health number or Rx number. Field 3 is an age range, as the criteria ask.
Print it, or paste it into CPhIR, Pharmapod, TPSC Cloud or whichever platform you use.
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.
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
Fourteen of the fifteen. None of them asks who you are.
What happened. Never the patient's name, address, phone, health number or Rx number.
Leave blank if not known.
A role, never a person's name. If it was you, choose your own role.
Everywhere the incident touched.
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
Field 14 is analysis rather than observation. Keeping it separate lets the report stay anonymous.
The Designated Manager's analysis, not the reporter's.
Take it away
Print it, or copy it into the platform your pharmacy uses. 15 of the fifteen are still blank: #13, #1, #2, #6, #5, #8, #9, #10, #3, #4, #7, #11, #12, #14, #15.
Medication incident worksheet
Medication incident — it reached the patient
Prepared October 12, 2026 at 7:58 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 — quoted in full, 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, plus a register, causal-factor analysis, CQI records and unique logins.