Ambulance Collision Report
North Dakota Department of Health
Division of Emergency Medical Services
600 E. Boulevard Ave. Dept. 301
Bismarck, ND 58505-0200
The following information is required to be reported under N.D.A.C 33-11-01.2-10.
The information submitted will be used for data collection purposes so that we may
determine future needs of EMS in North Dakota. This information must be reported
within thirty days of incident that involves personal injury or property damage
of more than one thousand dollars.
Please complete this report and submit it to the North Dakota Department of Health
when there has been an ambulance collision resulting in over $1000 in damage.
The information submitted here is for data collection purposes in order to determine
future needs of EMS in North Dakota and is mandated under N.D.A.C. 33-11-01.2-06.
Please do not leave any areas blank and answer all questions to the best of your
knowledge. You may be contacted if more information is needed.