This page provides a list of all questions found on the PSRP reporting form for nursing facilities. They are grouped alphabetically by the section of the form in which they appear. This list does not indicate which questions are required for all nursing facility reports nor which questions only appear for certain event types. A list of required questions can be found here: Required Fields for Nursing Facilities.

General Information

Summary, Cause and Action Plan Information

Harm Category

Event Information

Event Type-Specific Questions

Device, Equipment or Supply Event-Specific Questions

Fall Event-Specific Questions

HAI Event-Specific Questions

Medication or Other Substance Event-Specific Questions

Pressure Injury Event-Specific Questions

Contributing Factors

Review and Analysis Information