Volunteer EMS/FD Naloxone Administration Report 1. Question Title Case # Question Title County Adams Asotin Benton Chelan Clallam Clark Cowlitz Douglas Ferry Franklin Garfield Grant Grays Harbor Island Jefferson Kitsap Kittitas Lewis Lincoln Mason Okanogan Pacific Pend Oreille Pierce San Juan Skagit Skamania Spokane Stevens Thurston Wahkiakum Whatcom Yakima Question Title Agency Question Title Date of overdose event Date Date Question Title Time of arrival to overdose scene Time Time AM/PM - AM PM Question Title Zip code Question Title Type of place Outside (park, sidewalk, street, car, camp) Private home/apartment Hotel/motel Business Social service agency Other (please specify) Question Title Were police on the scene before you? Yes No N/A Neither arrived Next