Overdose Reporting Tool - Leeds, Grenville and Lanark District Health Unit

WHEN: Date of Incident (yyyy/mm/dd)

WHERE: Location of Incident

WHERE: Town/City or Township

Number of people who overdosed

Drug Format (pills, patches, powder, etc.)

Suspected drug(s) involved (brief-description)

How much Naloxone was used?

Phone

Email

Personal Health and Information Protection Act (PHIPA)

This information is being collected under the authority of the Personal Health and Information Protection Act (PHIPA) and will be kept confidential and anonymous. If you have any questions please call us at 1-800-660-5853 and ask for Harm Reduction. A summary of the reports submitted to this email will be published monthly 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.

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