Incident RBport- Submission Completed 

 

 

 

 

 

Incident Details
Date lncidentUnknown Location of nknown
Incident:
lnciden as admitted to Walker Methodist 6/27/2003 and currently

description: resides on 6 Gamble. She has diagioses which include Multiple Sclerosis and
Depression. This moming she reported to a nursing assistant that a man had
ouched her boob and told her it felt nice. During further interviews, -
repeated that an African male staff member had touched her breast and told her
't was sofi. She was not able to describe when this incident may have occurred,
her statements ranged from one week to quite awhile ago. She has not seen this
man since but would recognize him if she saw him and would recognize his
name if someone said it. She did say he was bold, short and average size. There
were other inconsistencies in describing the interaction such as what the mm
id and how she replied but she does believe this happened. -was asked
bout each staff member that works on her unit on a regular basis, those who
ve floated to her unit and those that have recently left Walker. She denied
any of them were the one who did this based on name. She doesn't want to
this man again but she is not afraid. -was pleasant and even laughing
uring this interview, An internal investigation is ongoing

 

 

 

Alleged Perpetrator Information

 

    

 

 

 

Name:
DOB: Addre
Gender: City/SflZi -
Relationship 15 there evidence of previous incident by alleged perpetrator: No
to Resident:
Nature of incident:

 

 


the alleged perpetrator

 

acility Staff

 

 

 

Guardian/Conservator Information/Power of Attorney/Responsible Persons

 

Work Phone:

  
  

Name:

--
Address Home Phone:
City/St/Zip:
Relationship ephew/ next of kin
to Resident:

 

 

 

 

 

 

 

 

Ants 'l/le/Zoll 5:24 PM