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Colorado Network Debriefing | Defusing | Or Other Entry Form
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✻
What is 2 + 5?
Type of Intervention
✻
Debriefing
Defusing
Education
Other
Your Name
✻
Email
✻
Team Name
✻
Date of Incident
✻
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2022
2023
2024
2025
2026
Hours - Incident to Intervention
✻
elapsed time from incident to session; rounded to the nearest full hour
Session Length - Hours
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length of session; rounded to the nearest quarter hour
Approximate Travel Time
✻
agency travel time for one team member; rounded to the nearest quarter hour
Number of Members
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number of this team's members acting as debriefers at this session
Agency requesting intervention
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name of requesting agency or main agency being debriefed - not code #
Agency Type
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two-digit code from "Agency List" relating to the type of agency being debriefed
Other Agencies
two-digit code from "Agency List" relating to the type of agency being debriefed; list all that apply
Number Debriefed
✻
number of persons from all agencies debriefed at this session
Nature of Incident
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Incident brief description of incident; not a code
Incident Type
✻
100 code from "Incident List" relating type of incident
Victim Category
✻
200 code from "Victim Category" describing the number and age group of victim of the incident
Coments