MERT Equipment Use Report Form
This form will provide us with the information necessary to adequately service 
your MERT equipment, provide debriefing to your staff, and/or review your first aid response.
For immediate/emergency attention please call 201-390-2608.

Company/Group Name  	 	:
Contact        			:
City           			:
State                      			:
Zip                        			:
Phone           			:
E-Mail Address  			:

What type of emergency did the team respond to?
How many MERT members were at the emergency?
Was the ambulance called?
Was the patient(s) transported to the hospital?
Was the MERT equipment taken to the scene of the emergency?
What MERT equipment was used/needs replacing?
Please list any other circumstances that you think we should know about: