Page History
Please click the link to download the file: ONP Quarterly Reporting Form Data Collection 2022.docx
...
Ontario Naloxone Program
Ministry of Health
...
...
...
...
...
...
...
...
...
...
...
Quarterly Reporting Form
...
...
...
...
...
...
...
...
...
...
...
ONP Site Name:
...
...
...
...
...
...
...
...
...
Quarter:
...
...
...
Contact Name:
...
...
...
...
...
Contact Email:
...
...
...
...
Contact Tel:
...
...
...
Select Organization Type
...
...
...
...
...
...
...
...
...
...
...
Core ONP Site/Naloxone Distribution Lead
...
...
Emergency Department
...
...
...
Fire Service
...
...
...
...
...
AIDS Service Organization
...
...
Expanded Access Organization
...
...
...
Police Service
...
...
...
...
...
Aboriginal Health Access Centre
...
...
Outreach Program
...
...
...
St. John Ambulance
...
...
...
...
...
Community Health Centre
...
...
Shelter
...
...
...
...
...
...
...
...
...
Consumption & Treatment Service
...
...
Withdrawal Management Program
...
...
...
...
...
...
...
...
...
Output
...
Number
...
Injectable Naloxone Distributed
...
...
Number of injectable naloxone kits distributed to individuals
...
...
Number of single refill injectable ampoules distributed to individuals
(1 box = 10 refill ampoules).
...
...
Nasal Spray Naloxone Distributed
...
...
Number of nasal spray naloxone kits distributed to individuals
...
...
Number of single refill nasal sprays distributed to individuals
(1 box = 2 refill sprays)
...
...
Individuals Trained
...
...
...
...
Due Dates
...
...
...
...
...
Q1 (Apr – Jun)
...
Q2 (Jul – Sep)
...
Q3 (Oct – Dec)
...
Q4 (Jan – Mar)
...
Aug 1
...
Nov 1
...
Feb 1
...
May 1
...
