LOS ANGELES COUNTY - DEPARTMENT OF HEALTH SERVICES
Radio Days Communication Failure Report
Date of Incident :
mm/dd/yyyy
Time of Incident :
hh:mm
Sequence # :
Agency :
Unit :
Location Address :
City :
Cross Streets :
Base Hospital :
Channel(s) Attempted :
Radio Type :
Problem Transmitting :
Garbled Transmission :
Problem Receiving :
Static :
No Response :
Other(see below) :
Problem Description :
Please Print a copy of this form for your records before submitting