Restrained Working Outside Environment Unrestrained Working Inside Building / Hospital Parked / Vehicle Occupant Restrained Unrestrained Working Outside Environment Working Inside Building / /
IndustryTerm
insurance policies / /
MedicalCondition
Minor Severe Moderate Personal Injury / serious injury / injury / illness / ALS / /
Organization
Bureau of Emergency Medical Services / New York State Department / Emergency Service / EMS Service / Other Party / Work Location Unrested Investigating Agency/Precinct State Police Local Police Department / NEW YORK STATE DEPARTMENT OF HEALTH Bureau / /
Person
Back Leg / Injury Spinal / Injury Exposure Spinal / Injury Spinal Injury Sprain / /
Position
Driver / Supervisor / No Ambulance Operator Driver / EMS Supervisor / general information relating / General / Personal Physician / / Sheriff / Critical Care Admission Deceased Personal Physician / Hospital General / Head / /
NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Emergency Medical Services Reportable Incident Form This form must be completed for any serious injury, illness or death of an EMS provider, patient or other individual in a