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Contra Costa EMS
 Event Reporting

The EMS Event Reporting Program is a comprehensive Patient Safety and EMS Provider Recognition program. Reporting is encouraged by all who encounter an actual or potential patient event, potential safety event, system concern, or exemplary care delivered within the Contra Costa County EMS system. Please use the online form below to pertinent information regarding the event - if you would prefer, you may download the EMS Event Reporting form and submit as directed on the form.
Questions and comments about this program can be sent to Craig Stroup, EMS QI Coordinator at

This information should originate from the provider involved and may be submitted anonymously. Please be advised that anonymous reporting may impact the ability to respond to your concern.

No patient names or other personal patient information should be reported on this form.

Reporting Party (do not complete for anonymous submission):

Incident Information (complete as much information as is available):

Please select all that apply to the issue you are reporting:

Details of Event: