AEAV AEAV AEAV AEAV AEAV Report an incident Report an incident of possible exposure to Ketamine ↓ Use this form to report an incident of possible exposure to Ketamine Name* First Last Branch*Contact email* Contact mobile*Must be an Australian mobile number, beginning with 04Case numberDate of incident* DD slash MM slash YYYY Time of incident* : Hours Minutes AM PM AM/PM Location of incident*Witness or partner*How did the potential exposure to Ketamine occur?* Administering to patient Broken ampoule Brief description of incident*Max 600 charactersThe information you submit in this incident report will be passed onto HR, the AEAV and you will receive a copy.EmailThis field is for validation purposes and should be left unchanged.
