EMS Radio Report Checklist Form
Complete this checklist to document your EMS radio or dispatch communication. Ensure all relevant communication details are accurately recorded.
Date and Time of Communication
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
EMS Unit Identifier
*
Dispatcher Name or ID
*
Type of Communication
*
Please Select
Routine Check
Incident Report
Status Update
Request for Assistance
Other
Location or Incident Address
*
Patient Age Group
Please Select
Adult
Child
Unknown
Brief Description of Situation
*
Actions Taken or Instructions Given
Radio Signal Quality
Please Select
Clear
Intermittent
Poor
Additional Notes
Submit Report
Should be Empty: