Voluntary Anonymous Reporting System

Please note that general complaints about a health care facility should be submitted to the Complaint hotline at 1-800-792-9770 or through the Complaint hotline web based system.

The Patient Safety Voluntary Anonymous System allows employees and professionals working at a health care facility to submit voluntary anonymous reports to the Department regarding preventable adverse events that resulted in injury to a specific patient.

In accordance with the Patient Safety Regulations, all NJ licensed healthcare facilities are required to:

  1. inform employees and health care professionals practicing at the health care facility of their option to file such voluntary anonymous reports.
  2. make this information available through patient or resident safety training programs and by prominently posting it in a location accessible to employees and health care professionals.

When submitting a voluntary anonymous report to Patient Safety, the following fields are required:

  • The patient’s last name
  • The facility name at which the event occurred
  • The type of event

Please complete as many fields as possible.

Please note: Reports should only be submitted through the Voluntary Anonymous System by an employee or healthcare professional if a specific patient had a serious injury related to healthcare.

Voluntary Anonymous Report Form

Last Reviewed: 3/10/2017