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Form reportable incident 2026
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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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doh reportable incident form
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