DOH
EMS Vehicle Collision & Personal Injury Report Instructions &
Form |
Frequently used forms
The forms listed below are provided to make interaction with different organizations more convenient to field personnel. Please feel free to print as many copies as required by your service. If you have any questions about the forms or their use, please contact the appropriate person at the Region.
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DOH Vehicle Collision and Personal
Injury Report The Pennsylvania Department of Health, EMS
Office, has adopted the attached EMS Vehicle
Collision and Personal Injury Report Form as the required
reporting form for use by ambulance services that are involved
in an ambulance vehicle accident that is reportable under 75
Pa.C.S., and an accident or injury to an individual that occurs
in the line of duty of the ambulance service that results in
a fatality, or medical treatment at a facility.
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EMT Class Registration Form This
form is used to register students for EMT Classes held at the Chester
County Department of Emergency Services. Forms should be filled
out completely and mailed or faxed to the Department prior
to the
course registration deadline. |
EMS Counci Awards Nomination Form Applications for these awards may be based on a pattern of activities that have culminated in a significant improvement of an Emergency Medical Services System in Chester County. The application may also be based on a single unusual event that was beyond ordinary duty. Each application must be clearly and completely documented to be considered. Where individual events are cited, they must be documented in detail giving times, places, description of event, names of witnesses, etc. Applications for a pattern of activities must be all inclusive providing details of activities, dates and describing the specific impact that the individual has had on EMS in their region. Applications recognizing a single event must be based on that event occurring in the calendar year. |