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LOSS Incoming Call Form
Incoming Call Form
Call Information
Phone Dispatcher
Date of Call
Time of Call
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AM
PM
Name of Person Calling
Investigator at Scene
Phone Number of Investigator at Scene
Name of Law Enforcement at scene and/or police department (Detectives Only)
Should team wait for 2nd call?
Yes
No
Other
Other
Deceased Information
Deceased First Name
Deceased Last Name
Address
*
Address
Street Address
Street Address
Apartment/Suite #
Apartment/Suite #
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Approximate Age of Deceased
Gender
Male
Female
Unknown
Marital Status
Single
Married
Divorced
Race/Cultural Specifics (Country of Origin - if applicable)
Method of Death
Scene Information
Can you tell me approximately how many survivors are present and their relationship(s) to the deceased? (i.e, Are there 10 friends there and a sister?)
Team Members Activated
*
List team members activated for the scene (i.e. Team Lead, Team Member). Phone Dispatcher: Remember to text volunteers activated with pertinent info including team member(s) name, phone number, and location of meeting place before going to the scene.
Central Meeting Location
Submit
If you are human, leave this field blank.