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DISASTER RISK REDUCTION MANAGEMENT DEPARTMENT

Page Title

DATA NEED FOR THE ISSUANCE OF DOCUMENTS

CUSTOMER FEEDBACK FORM

1. Services Needed/Availed

2. Incident Date

3. Name

4. Contact Number

5. Flow of Procedure

6. Quality of Service Provided

7. Timeliness of service Provided

8. Professionalism & Courtesy

9. Cleanliness of office

CCTV FOOTAGE REQUEST FORM

1. Type of Request

2. Date & Time of Request

3. Personal Details

• Full Name

• Address

• Relation to the Subject

• Contact Number

• Type of ID

4. Incident Details (Date, Time and Location of Incident)

5. Description of Incident

6. Printed Name and Signature

PRE-HOSPITAL PATIENT CARE REPORT

1. Incident Information

• Nature of Call

• Type of Emergency

• Date / Time of Call

• Location

2. Patient Information

• Patient Name

• Patient Address

• Age / Gender

• Contact Number

• Next of Kin & Contact Number

3. Patient Assessment

• Spine

• Airway

• Breathing

• Contact Number

• Next of Kin & Contact Number

4. Physical Examination

5. Secondary Survey

• Signs and Symptoms

• Allergies

• Medication

• Past Medical History

• Last Intake

• Event

CASE INFORMATION SHEET

1. Case Number

2. Date & Time

3. Incident Classification

4. Incident Location

• Barangay

• House Number & Street

• Landmark

• Name Of Caller & Callback Number

5. Category of Emergency

•          For Police Emergency

a.    Type of Incident

b.    Time of Incident

c.    Suspect Present

d.    Injured Victims

•          For Fire Emergency

a.    Type of Fire Incident

b.    Fire Ongoing

c.    Injured/Trapped Victims

•          For Medical Emergency

a.    Type of Medical Incident

b.    Time of Incident

c.    Patient Conscious/Patient Breathing

•          For Rescue Assistance

a.    Type of Rescue Incident

b.    Time of Incident

c.    Victim conscious / victim breathing

6. Dispatcher Remarks

7. Ambulance Crew