El Paso/Teller County E911 Field EMD Responder Form

This form is a tool for evaluating the efficiency, accuracy, and effectiveness of the Priority Dispatch System. Please report exceptional services as well as errors. The data assembled will be utilized in assessing the response to various codes, and for Quality Assurance of the Dispatch system.

All data collected on this form will be sent to Troy Pring at troy.pring@elpasoteller911.org. Troy can also be reached by phone at (719) 785-1965.

Please include as much information as possible in this form.

Fields marked (*) are required.

Full Name:(*)	E-Mail Address:(*)
Shift:	Alarm #:
Time and Date of Call:
Address:	Dispatch Code Given:
Was Code Given Correct? (Check box if YES):
Situation:	Comments: