Naloxone Reporting Form Search Submit Search Print this Page Home » Health Information » Drug Use & Harm Reduction » Overdose Prevention & Naloxone » Naloxone Reporting Form Naloxone Program ReportingOrganization Name(Required)Month(Required)Contact Person(Required) First Name Last Name Email(Required) Phone(Required)Key Outcomes for the MonthNumber of individuals trained to administer Naloxone (clients, friends and/or family)(Required)Number of Naloxone kits distributed to individuals (clients, friends and/or family)(Required)Number of expired Naloxone kits(Required)Number of IndividualsNumber of individuals who reported administering or receiving Naloxone, including how many doses were given per administration1 Dose2 Doses3 Doses4 Doses5 DosesNumber of times that 911 was called when Naloxone was administered(Required)Additional InformationPlease provide any additional information that you feel is pertinent for the ministry to know about, including anecdotal trends and reports:Information about drug trends in your communityA need for Naloxone in your community that is not being filledCAPTCHA If you have any questions or concerns, please contact Harm Reduction at 613-345-5685 or 1-800-660-5853.