Incident Report - OKARR, Oklahoma Alliance for Recovery Resources

When reporting overdoses and/or life-threatening events, please be as detailed as possible including only factual information.

Company(Required)

Full Name of Person Involved in the Incident(Required)

Residence Certification Status(Required)

Residence NARR Level(Required)

Date of Incident(Required)

If other, please explain

Describe the incident(Required)

What actions were performed?(Required)

E.g. CPR, Narcan, 911, etc.

What was this person's "drug of choice", if applicable?

Were there any pertinent behaviors prior to the incident or overdose that you can recall? What were those behaviors?(Required)

If called, how soon were emergency responders called and how long did it take them to arrive?

Was anyone notified other than emergency responders?

What has been or will be done to assess and address the community in the aftermath?

Gender of Client/Staff involved, if applicable

Age of Client/Staff involved

If non-resident, which state did they come from?

If non-resident, how long have they lived in Oklahoma?

If non-resident, how did they come to Oklahoma?

If resident, please list their outpatient provider

Please describe their last known contact with staff

Your Signature(Required)