Patient Safety Incident Report Form

Patient Safety Incident Reports can be completed by Paramedics, Management or others wishing to report a concern or variance. Please complete in as much detail as possible to provide context for full analysis. Note: please don’t include any patient health information (PHI) in your responses.

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Please enter your EHSN in the appropriate box if available
Please enter your EHSN in the appropriate box if available
Click Submit to complete this form

The information gathered is used by the RPPEO to help us improve process and identify potential issues through the quality process in place. This information is also shared with your service.

If you indicated that you would like someone to follow up with you, please allow us up to 2 weeks to respond.

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Local: 613-737-7228 | Long Distance: 877-587-7736

Ottawa, 2475 Don Reid Drive, Ottawa, On, K1H 1E2
Kingston, 400-1471 John Counter Blvd, Kingston, ON, K7M 8S8