ProQA Feedback Form
This form will give you a venue to report concerns or positive outcomes regarding incidents. Here are some examples of when the form should be used: Dispatch codes not matching with what was found on the scene. Actual conditions found at the scene (positive or negative). DLS (Dispatch Life Support) instructions were given, and it made a difference in the outcome of the incident (i.e. CPR instructions, bleeding control, etc.).
There can be numerous reasons why the dispatch code may not match up with what was found at the scene. It's up to the QUI (Quality Improvement Unit) personnel to investigate objectively in order to ascertain how the the code was acheived. Was the emergency dispatcher compliant? What did the caller and/or dispatcher actually say? All submitted forms will be reviewed by the QUI. The goal will be to investigate and produce the outcome to the person who submitted the form within two weeks. Copies of the report will be routed to the Shift Supervisor for review with the call taker or dispatcher when appropriate. Please use the form to report above examples and any other issues that you feel should be addressed by Lee Control Supervisory staff.
Unit ID:	(ie: Truck 75 or IMTK75)
Incident Date:
Approximate Time:
Incident Number (if known):	(ie: F201912180010)
Protocol / procedure referenced:
Your Email Address:	(for followup on findings)
Details:
Type the number Nine One One Here: