General Incident Report:  

           

 Use this form to document general incidents that go beyond the normal course of operations that you feel should be reported to leadership for investigation and follow-up, or simply unusual occurrences that should be documented.  Examples of incidents that should be reported include:  a complaint that is received; a verbal disagreement or confrontation with a hospital or public safety employee; an issue that affects a particular response to a call; or a problem or issue related to a transfer.  Forms submitted are reviewed by the Vice President of Resource Delivery.


 
Incident Title *
Life EMS Operation: *
Location: *
Run # (if applicable)
Report Type:
Date:
Your Name: *
Your Email Address:
Your Phone #:
Names of Other Associates Involved:
If vehicle-related, Category:
Vehicle 4-digit ID:
Vehicle ID (EMS 1, 256, etc.)
If equipment or supply issue, select category:
Equipment Description:
Unit equipment is from:
Description of Incident/Damage/Failure: *
How did event occur?
If a failure, location of failure:
When did failure occur?
If a Failure, Date and Time:
Other/Additional Information: