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  • Patient Safety Event Report

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  • If the prevention or mitigation suggestion has been implemented please report the number of weeks that occurred between the identification of the mitigation and the implementation of the mitigation.

  • If the failure or malfunction of a device or piece of  equipment is integral to or caused the event, please fill in the following information:




Contact Us

Center for Leadership, Innovation and Research in EMS • P.O. Box 2286 • St. Cloud, Minnesota 56302
800-342-7849 or 320-229-3621 • 320.251.8154 (fax) • Contact Us