Fire Incident Report Form

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**FOR ATCEMS PERSONNEL ONLY!**
This form is to report incidents between ATCEMS personnel, patients, or others on scene with AFD firefighter personnel or ESD firefighters. This is not here as free space to complain, spread rumors, or describe incidents that occur outside of work. This can be used for good, positive interactions to send kudos.

This is not intended to be punitive in nature. The goal behind this is data collection for better understanding behind incidents that occur and why so we can work towards finding solutions.

If you experience harassment away from work, report it to your commander of record, a chief, and/or HR.

PLEASE USE YOUR PERSONAL EMAIL ADDRESS, NOT YOUR CITY EMAIL.

Email *

Name/EM number
(#s ONLY ie: Doe EM0000 = Doe/0000)
*

Medic unit:
(if Comm/C4/CHP write that instead)
*

Incident number:
(If station issue write N/A or station #) *

Describe the incident? (ONE call only–not your entire shift) *

Was this incident reported to chain of command?
*

YES

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