South Central Minnesota EMS System

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Home
Upcoming Events
About Us
Child Passenger Safety
Personnel Portal
Getting Involved in EMS
Agency Resources
Contact
Privacy Policy
MN EMS Regions
Continuing Education Modules

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CISM Team Follow Up Report

Date:

Contact:

Facilitator:

Organization:

Original Date of Service:

Type of Service:

Debrief

Defuse

Peer

Other

Type of Service (if other):

Type of Incident:

Accident

Industrial

Domestic

Suicide

Line-of-Duty Death

Other

Type of Incident (if other):

Describe feelings, emotions, and/or expressions:

Plan of action, decisions, or recommendations made:

Contact's overall Impression of organization function:

Indications for further services?

Yes

No

Were referrals given?

Yes

No

If "Yes," location of referral:

Additional Comments:

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Eagle Lake, Minnesota

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