Ems Service Monthly Report Template

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EMS Service Monthly Report Template
Version 1.0
The following is a template which can be used by EMS leaders to report their monthly activates
to the local, regional, or county government officials, which they service. Once a format is
adopted it should be used for each monthly reporting cycle.
It is important to note that once this report is turned into your government officials it should also
be posted on your agency web page and be kept current monthly. Even if your local officials do
th
not require this reporting, you want your activity on record. Annually create a 13
report and
aggregate all the date from the individual 12 monthly reports and submit it with your
budget/subsidy request.
Name of Agency
Logo on your letter head
Month being reported: January, 2014
Call Volume and Activity
Total # of EMS Requests for the month
______
Total # of EMS Transports for the month
______
Total # of Cancelled Calls for the month
______
Total # of Public Assistance Calls (i.e. lift assists)
______
Total # of EMS Stand-by Requests (i.e. Fire or police)
______
Number of mutual aid calls to other Towns
______
Number of calls requiring more than one ambulance
______
Number of calls 06:00-18:00
______
Number of calls 18:00-06:00
______
Total number of paid staff hours
EMS calls
______
Community events
______
Training
______
Total number of volunteer staff hours
EMS calls
______
Community events
______
Training
______
On the next page list out all of the community, training and
fundraising events that were accomplished that month.
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