Please use the form below to submit commendations or complaints.

"*" indicates required fields

Reporting Party


Witness Information

Witness Name*
Witness Name
Witness Name

Incident Information

MM slash DD slash YYYY

Nature of Commendation or Complaint

Briefly state the nature of the commendable action or complaint. What is it that one or more of our members did, or failed to do? What were the conditions or circumstances at the time of the incident, and what resulted?

Please Sign & Date

MM slash DD slash YYYY

You can also download our Commendations / Complaints form and submit via mail or in person to:

Western Berks Ambulance
2506 Belmont Ave
West Lawn, PA 19609