Police Call Reporting
Use this form to report a Police-type call to which you were dispatched. Do not include names, other than yours and/or your partners or addresses. This information may be shared with management and be used to improve and identify Health and Safety concerns related to police calls.
Email *
Your Name/Partner *
Vehicle Number
Date
MM
/
DD
/
YYYY
Time
Time
:
Run Number *
Please add a summary of the call details *
Did you stage?
Clear selection
Did you perform a SSA?
Clear selection
If NO SSA why did you not perform one?
Did call information include a police request for medical clearance with no presenting complaint? ("police want checked out")
Clear selection
Method of transport
Clear selection
Did the call appear to originate from RR?
Clear selection
Did the call information indicate an EXISTING medical or traumatic complaint?
Clear selection
Did the call information indicate violence?
Clear selection
By the time you went 10-7 did you have enough information to make an informed decision on scene safety?
Clear selection
Were you in danger at any point during the call?
Clear selection
Did a supervisor attend the scene?
Clear selection
Name of Supervisor
Anything else you would like to add?
Submit
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