Shelby County Emergency Services Association
Safety System Close Call Reporting
The following form is collected anonymously, and processed for statistical use only.  Information will be used to trend
responses that result in unusual amounts of driving, or operational complaints.  Training issues will be identified and
training offered to correct deficiencies.  We ask anyone using this system to focus on the Event, not a specific person.
 For example if you know the driver of a Ambulance, and you see them operating in an unsafe manner  we want you to
focus on why you thought the Ambulance was being operated in an unsafe manner.  Be specific about location, day
and time.  Thank you for your continued effort in making Shelby County EMS/Fire Departments function at a safer
level.
Close Call Reporting Form
* Required Field
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Unsafe
Action:
Weather:
Traffic Load:
(Light/Mod/Heavy)
Questions, comments, or feedback:
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