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 address *
Your Name/Partner *
Your answer
Vehicle Number
Your answer
Date
MM
/
DD
/
YYYY
Time
Time
:
Run Number *
Your answer
Please add a summary of the call details *
Your answer
Did you stage?
Did you perform a SSA?
If NO SSA why did you not perform one?
Your answer
Did call information include a police request for medical clearance with no presenting complaint? ("police want checked out")
Method of transport
Did the call appear to originate from RR?
Did the call information indicate an EXISTING medical or traumatic complaint?
Did the call information indicate violence?
By the time you went 10-7 did you have enough information to make an informed decision on scene safety?
Were you in danger at any point during the call?
Did a supervisor attend the scene?
Name of Supervisor
Your answer
Anything else you would like to add?
Your answer
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