Report ketamine exposure – Ambulance Employees Australia

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Use this form to report an incident of possible exposure to Ketamine

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This field is for validation purposes and should be left unchanged.
Name*
First Last
Branch*
Contact email*
Contact mobile*
Must be an Australian mobile number, beginning with 04
Case number
Date of incident*
Time of incident*

: Hours

Minutes

AM/PM
Location of incident*
Witness or partner*
How did the potential exposure to Ketamine occur?*
- Administering to patient
- Broken ampoule
Brief description of incident*
Max 600 characters
The information you submit in this incident report will be passed onto HR, the AEAV and you will receive a copy.