Home
Health Topics
Drug Overdose and Tainted Drugs Report Form

Drug Overdose and Tainted Drugs Report Form

When: Date of incident*
MM slash DD slash YYYY
Where: Location of incident*
What: Occurred (check all that apply)
- OD fatal
- OD non-fatal
- Tainted drugs suspected
Number of people who overdosed
Drug Format (pills, patches, powder, etc.)*
Suspected drug(s) involved (brief description)*
Was 911 called?*
- Yes
- No
- Unknown
Was Naloxone administered?*
- Yes
- No
- Unknown
How many Naloxone vials were used?*
If possible, please describe what happened (context/background)*

This information is being collected under the authority of the Personal Information Protection and Electronic Documents Act (PIPEDA) and will be kept confidential and anonymous.

A summary of the reports submitted through this form will be published quarterly or as needed for the use of community partners to help continue to identify trends and to reduce harms associated with overdoses and tainted/toxic drugs in our community. No personal information will be included in these summary reports.