Praisetab - INCIDENTREPORT

Nature of Report

Medical

Security

Date of Incident

Time of Incident

Location of Incident

Number of people involved in incident

Please fill out separate forms for each person involved.

Person Involved in the Incident

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Birthdate

Gender

Phone Number

Nature of Illness:

Heart Rate:

Blood Pressure

Treatment Given

Current Medications

Allergies

Past Medical History

Transported to Hospital?

Yes

No

Squad

Team Member(s) on Scene

Were the police called?

Yes

No

Was the person arrested?

Yes

No

Incident Report Number

Was a No-Trespass order issued?

Yes

No

TBD

Notes or Comments