Faulkner Co. Emergency Squad

Date: 10/20/2012Location: Report By:

Officer On Scene: Yes ☐ No ☐ #	Run #

Call Time: 10-96: 10-97: 10-98: 10-22:

Transport Times: 10-96: 10-97: 10-98:

Members:

On Scene:

Emergency: ☐ Non-Emergency ☐

Run Type:	MVA: ☐	Corner: ☐	Dive Operation: ☐

Medical: ☐	Transport: ☐	Recovery: ☐

Structure Fire: ☐	Search: ☐	Water Rescue: ☐	Event: ☐	Other:

Other Agencies:

On Scene:

Fax # 501-329-7262

Detailed Incident Information: