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
