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.
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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
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Did the call appear to originate from RR?
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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?
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