Report an on-duty incident

Use this form after the scene is safe to document violence, threats, or aggression involving first responders.

This is not an emergency service. If there is immediate danger, call 911 or follow your agency's emergency procedures first.

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Step 1

Agency

Truck apparatus or unit number

State*

County / parish / borough

Service area*

Service type involved*

Air MedicalGround AmbulanceCommunity Paramedic VisitOther

When did it happen?*

When during the call or transport?*

Involvement not entered • Role not entered • Employment type not entered

Harm level not entered • Destination not entered • Distance not entered

Skip this section if you only need to complete the required report.

Narrative not entered • PHI confirmation pending • Reporting notice pending

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