1. Fill in the basic information: including the supervisor's name, contact information and department, etc.

2. Describe the content of the complaint: describe the problems reflected by the mass supervisor in detail, including the time, place, people involved and the incident.

3. Assessing the impact of the incident: Assessing the impact of the incident on the hospital's reputation, patient safety and medical quality.

4. Handling situation: record the hospital's handling of the incident in detail, including handling methods, handling time, handling results, etc.

5. Feedback and improvement: record the hospital's feedback on the incident and improvement measures, including the handling of relevant personnel and process improvement.

6. Signature: Finally, please fill in your signature and indicate the date.