Illinois Saves Overdose

Overdose Administration Form - Bystander

If you are a friend, family member or outreach worker and have administered the medication naloxone, please complete the following fields to the best of your ability.

We prefer that you use your best guess to complete each field rather than leave blank and not answer. Please note your data is stored anonymously and securely. Thank you for all your efforts.

Location of Naloxone Administration
Site Type*

Naloxone Administration - Condition of Person
Did the person survive?*

Naloxone type*

Dosage needed* (?)
Was there a 911 call made?*

Was the person conscious before naloxone was used?

About the Person


Race and Ethnicity*

Notes (optional)
Illinois Saves OD is funded by the Substance Abuse and Mental Health Services Administration through the Opioid State Targeted Response grant administered by the Illinois Department of Human Services, Division of Substance Use Prevention and Recovery. (TI-080231). | Contact us: