Nurse Aide Site Incident Report

Site Irregularity Reporting:

Any unplanned event that occurs during a candidate's test session should be considered an irregularity.

It is critical that you complete SIRs for irregular events, this provides Prometric and its testing clients with a record of every irregularity.

You may complete SIRs at any time during the testing day, but you must report them on the day the incident occurs.

Nurse Aide Program *

Site Code *

Submitted by *

Email Address

Test Date * +

Escalated *

Case # Provided by GTCS (Global Test Center Support)

Number of Candidates on Roster *

Number of No Show Candidates *

Candidates Impacted *

Documented Issues - check all that apply

Force Majeure

Weather Issues

Campus Emergency

Loss of Power

Candidate Details -Add all information in the comments section.

Leave this area blank and add all notes in comments setcion. You may have to abbreviate some of your words due to the character limit.

Candidate(s) Name 1

Candidate(s) Eligibility Code 1

Time of Incident 1

Note 1

Candidate(s) Name 2

Candidate(s) Eligibility Code 2

Time of Incident 2

Note 2

Candidate(s) Name 3

Candidate(s) Eligibility Code 3

Time of Incident 3

Note 3

Candidate(s) Name 4

Candidate(s) Eligibility Code 4

Time of Incident 4

Note 4

Candidate(s) Name 5

Candidate(s) Eligibility Code 5

Time of Incident 5

Note 5

Candidate(s) Name 6

Candidate(s) Eligibility Code 6

Time of Incident 6

Note 6

Candidate(s) Name 7

Candidate(s) Eligibility Code 7

Time of Incident 7

Note 7

Candidate(s) Name 8

Candidate(s) Eligibility Code 8

Time of Incident 8

Note 8

Additional Information

Comments

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