Vernon Emergency Medical ServicesIncident Reporting Form

Section 1: Incident Details

Weather During Incident:

Section 2: Incident Questions

1) Did this incident happen on a call? -- Select -- Yes No 2) Was a member injured? -- Select -- Yes No 3) Was a patient injured? -- Select -- Yes No 4) Were police notified? -- Select -- Yes No 5) Was a line officer notified? -- Select -- Yes No 6) Is this a personnel issue? -- Select -- Yes No 7) Is this an Operational/Equipment Issue? -- Select -- Yes No 8) Is this a Dispatching Issue? -- Select -- Yes No 9) Did this involve another VEMS Volunteer? -- Select -- Yes No 10) Does this involve another agency? -- Select -- Yes No

Section 3: Property Damage Report

Section 4: Reference Documents

Click below to view or download related documents:

• Township Accident Report
• Township Injury Report
• VEMS Policy - Injury & Workmans Comp