Stage 1 - Critical information

Hello, focus on call, this is...

Activate time stamp of call
What is the reason for this call?

Is this a life threatening situation?

Have emergency services been contacted?

If yes, which departments?
What time did you call the emergency services?

Have emergency services responded?

If yes, what time did they arrive?

Do you require further on site support?

Stage 2 - Incident information

Client(s) involved

Location of incident
Cat 1 or Cat 2 incident - What type?
Client health related - What type?
Emergency maintenance - What type?
Medication related - What type?

Staffing related - What type?

Provision of general information? Provide details...

Staff member seeking information? Provide details...

Stage 3 - Response to caller
Type of response

Provide details of response

Stage 4 - Post call actions
On call receiver - Signature
On call receiver - Verify time and date
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.