Ambulance Collision Report


       North Dakota Department of Health
       Division of Emergency Medical Services
       600 E. Boulevard Ave. Dept. 301
       Bismarck, ND 58505-0200

The following information is required to be reported under N.D.A.C 33-11-01.2-10. The information submitted will be used for data collection purposes so that we may determine future needs of EMS in North Dakota. This information must be reported within thirty days of incident that involves personal injury or property damage of more than one thousand dollars.

Please complete this report and submit it to the North Dakota Department of Health when there has been an ambulance collision resulting in over $1000 in damage.


 

 






 


Captcha* Enter the code
shown on the left:

 

 

The information submitted here is for data collection purposes in order to determine future needs of EMS in North Dakota and is mandated under N.D.A.C. 33-11-01.2-06. Please do not leave any areas blank and answer all questions to the best of your knowledge. You may be contacted if more information is needed.