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 number Date 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.PhoneThis field is for validation purposes and should be left unchanged.
