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* Date Format: DD slash MM slash YYYY Time of incident* : HH MM AM PM Location of incident*Witness or partner*How did the potential exposure to Ketamine occur?*Administering to patientBroken ampouleBrief 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.NameThis field is for validation purposes and should be left unchanged.
