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Paramedic Suicide Attempt Reporting Tool

This paramedic suicide attempt tool is intended to be used for these use cases:

(1)    Current employment or volunteer service as any level of paramedic, dispatcher, manager, student, or ancillary support personnel.

(2)    Significant past employment or volunteer service as any level of paramedic, dispatcher, manager, student, or ancillary support personnel.

 

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Demographics
Demographic Information

E.V.E.N.T. Suicide Attempt EVENT Report

RadDatePicker
Open the calendar popup.
RadDatePicker
Open the calendar popup.

"Ctrl-Click" Selects Multiple
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Event Information
Near Miss Event Information
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Reporter
Reporter Information
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Patient
Patient Information
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Other
Other Information

Thank you for taking the time to report this event. If you would like to receive these and patient safety events when reported, email us and we will add you to the Google Group for the project.

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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