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Click ‘Get Form’ to open the Reportable Incident Form in the editor.
Begin by filling out the general information section, including the EMS Service Name, NYS EMS Agency Code, and contact details. Ensure accuracy as this information is crucial for follow-up.
Proceed to Section 1 if a patient was injured or died due to EMS involvement. Provide detailed patient information such as age, gender, and pre-event condition.
If applicable, complete Section 2 for motor vehicle crashes involving injuries or fatalities. Include details about the vehicles involved and any relevant circumstances.
For incidents involving EMS personnel injuries or fatalities, fill out Section 3 with their details and mechanism of injury.
Complete Sections 4 and 5 if there were equipment failures or allegations of substance influence affecting treatment.
Finally, review all sections for completeness before submitting your form through our platform.
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We've got more versions of the form reportable incident form. Select the right form reportable incident version from the list and start editing it straight away!
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