Incident Reporting

Before you file your voluntary report...

Please Note

Southside Virginia Emergency Crew welcomes good faith reports of compliance concerns and/or possible violations.  This reporting tool should only be used to report incidents related to privacy, security or other compliance issues.  All reports are reviewed and prioritized upon submission.

  • Report only facts of the incident and be as detailed as possible
  • Most fields on the form are required but please fill out all fields for faster service
  • Do not disclose Protected Health Information in the form or description of incident. 

Should your report lead to the opening of a formal investigation, you will be contacted and provided instructions on how to proceed including submitting required authorizations for processing.

Compliance Incident Reporting Form