  Ambulance Fire Police Time called Time arrived ………………... ………………...  First Aid Was permission given to perform first aid? Yes / No Other  …………………..……….. member(s) responding to incident Action taken   Seek medical advice Report incident to Police Other (specify) ………………………………………………….. Incident report completed by Name Signature Date _ / / Supervisor / Shift Supervisor / Duty Manager Name Signature Date _ / / Service Area Manager / Facility Manager Name Signature Date _ / /   Additional notes Maintenance request Hazard inspection
Ambulance  Fire  Police Time called ………………... Time arrived ………………... First Aid  Was permission given to perform first aid? Yes / No  Other …………………..……….. member(s) responding to incident Action taken Seek medical advice  Report incident to Police  Other (specify) ………………………………………………….. Incident report completed by Name Signature Date _ / / Supervisor / Shift Supervisor / Duty Manager Name Signature Date _ / / Service Area Manager / Facility Manager Name Signature Date _ / / Additional notes  Maintenance request  Hazard inspection