​For Healthcare Employee Use Only

If you are a healthcare worker and believe a patient in your facility suffered an unanticipated injury involving clinical care, your first obligation is to report this internally via your organization's patient safety plan. If you are not satisfied with the manner the report was handled by the organization, you can submit an Anonymous Report to the Pennsylvania Patient Safety Authority. Please note that submitting an Anonymous Report to the Pennsylvania Patient Safety Authority does not also notify the Pennsylvania Department of Health.

All information submitted via this process is confidential and will be held in strictest confidence by the Pennsylvania Patient Safety Authority.

To submit an Anonymous Report, click here to access the reporting form. Complete this form to the best of your ability and return to the Pennsylvania Patient Safety Authority at:

Pennsylvania Patient Safety Authority
333 Market Street - Lobby Level
Harrisburg, PA 17101

Or via email to:
PatientSafetyAuthority@PA.gov

If you are not a healthcare worker, do not use this form. You can submit a complaint to the Department of Health at: https://apps.health.pa.gov/dohforms/FacilityComplaint.aspx.

Anonymous Reporting