Call Dispatch Log

• Site

• Dispatch Date

  Date

• Prepared by (Full Name)

• Location
  Address

Dispatch Log

• Call received (Date and Time)

  Date

• Source of call

• Call back number

• Response location (Name of destination or address)
  Address

• Complaint

• Unit dispatch time

  Date

• Unit en route time

  Date

• Time unit arrived on the scene

  Date

• Time unit left the scene

  Date

• Time arrived at destination

  Date
• Destination of patient (Name of destination or address)
  Address

Completion

• Full Name and Signature

  Sign