Get R426-5-3100 (7), (8) Report Form - Utah.gov Wordpress

Filling out the R426-5-3100 (7), (8) Report Form is an essential process for reporting incidents related to emergency medical services in Utah. This guide will help you navigate the form effectively, ensuring that all necessary information is captured accurately.

Follow the steps to complete the report form online.

1. Click the ‘Get Form’ button to access the report form. This action will open the form in your designated document editor.
2. Enter today’s date in the appropriate field to indicate when the report is being completed.
3. Fill in the name of the reporting individual. This should be the person completing the form.
4. Provide a valid phone number and email address for the reporting individual. This contact information may be necessary for follow-up.
5. Input the name of the EMS individual involved in the incident. This is crucial for identifying those directly affected by the situation.
6. Enter the EMS ID related to the individual involved. It helps in recognizing their proper credentials.
7. Specify the date of the incident in the designated field. This is important for chronological accuracy.
8. Describe the nature of the incident briefly, summarizing the key aspects of what occurred.
9. Provide a detailed description of the incident. Include all relevant facts that can aid in understanding the situation comprehensively.
10. Enter the location where the incident occurred to provide context regarding where the event took place.
11. Document the actions taken by the agency to date. This can include any immediate responses or interventions that were implemented.
12. List the EMS individual’s affiliated agencies, which can provide additional context about the individual's professional background.
13. Once you have filled out all required fields, review the information for accuracy. Make any necessary edits.
14. After completing the form, you can save your changes, download a copy, and print it for your records or sharing with others.
15. Share the completed form with the appropriate recipient by sending it to: BEMS Attn: CCEU, PO Box 142004, Salt Lake City, UT 84114-2004, or by fax to (801) 323-1563.

Complete the R426-5-3100 (7), (8) Report Form online today to ensure your incident is reported accurately and promptly.