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Contra Costa EMS
 Event Reporting

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 Jesse Allured, EMS Program 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: