Violations of Compliance Form

Pennsylvania Ambulance, LLC

Web Base Reporting Form

Violations of Compliance Program Policies or Procedures


Pennsylvania Ambulance has establish and maintains lines of communication that our personnel and others may use to report complaints and concerns regarding non compliant conduct of our personnel and of any agents or subcontractors we may use. Employees may use this form to report any incidents of potential violations or concerns regarding Compliance Program policies and procedures including the Code of Conduct. Additionally, employees may report violations directly to their supervisor or the Pennsylvania Ambulance’s Compliance Officer.  This form will also allow for anonymous reports of compliance concerns.  We will treat such reports as confidential to the extent reasonably possible

Pennsylvania Ambulance will not punish any personnel who, in good faith, report what they reasonably believe to be a violation of our Compliance Program policies and procedures, including our Code of Conduct, or any other act of wrongdoing.  We will comply with all protections in applicable law regarding anti-retaliation for reporting of potential violations of law. (Please refer toPennsylvania Ambulance Compliance Plan Section F).