The EMS regulations, §1005.10(e)(i) requires ambulance services to report, in a form or manner prescribed by the Department, to the appropriate regional EMS council an ambulance vehicle accident that is reportable under 75 Pa.C.S., and an accident or injury to an individual that occurs in the line of duty of the ambulance service that results in a fatality, or medical treatment at a medical treatment facility. This revised form has been adopted by the Pennsylvania Department of Health, EMS Office to meet the requirements of the regulations.

Link to instructions for completion of EMS Vehicle Collision Form.

Click Here to download EMS Vehicle Collision Form.