ZMC 24G IV

ZMC 24G IV Complaint Form

Please fill out the following complaint form if difficulties are encountered using the ZMC 24G IV access. The goal will be to objectively submit summary of all complaints to get the situation addressed.

* Indicates required field

NAME *

Department *

Position *

Date of Incident *

Batch No./Lot No. *

Nature of Complaint (check all that apply) *

Cannula wall was pierced and split by the needle, with protruding needle placing patient at risk of damage and doctor at risk of needle stick injury Difficulty piercing skin with resultant damage to cannula Unable to thread access in vein No flash back Other

Fill out if other *

Other comments on incident *

Please click here if you think replacing this brand of 24G IV with a safer alternative will help. *

Yes No

Submit

​ZMC 24G IV Complaint Form

ZMC 24G IV Complaint Form