Peer Support Intervention Form (New York State) Category One-On-One Demobilization Defusing Debriefing Follow-Up 1. Debriefers’ Names (and agency if other than NY):2. Debriefers’ Names (and agency if other than NY):3. Debriefers’ Names (and agency if other than NY):4. Debriefers’ Names (and agency if other than NY):Nature of Incident:Location of Incident:Incident Date: MM slash DD slash YYYY Agencies in Defusing or Debriefing:Number of Persons attending (excluding PST team):Length of Session:Description of Scene/Session:FacilitatorDate MM slash DD slash YYYY
