A to Z
Data &
Forms &
News &
Licensing &
Rules &
Public Health
Adolescent Suicide Attempt Data System
By law, Oregon hospitals are required to report adolescent suicide attempts to the Oregon Public Health Division.

  • Estimate the magnitude of suicide attempts among Oregon adolescents and monitor possible increases, decreases and trends.
  • Understand factors associated with suicide and suicide attempts among adolescents.
  • Increase public awareness and develop programs that support suicide prevention.
  1. For each attempt, a reporting facility must submit the following form to the Injury Prevention Program: Adolescent Suicide Attempt Report Form (pdf).
  2. For facilities where no attempts have occurred within a reporting period (month), the following form must be submitted to the Injury Prevention Program: ASADS Zero Attempts Form (pdf).
  3. Forms should be submitted by the 15th day of each month, for events that occurred in the previous month. Please note: for no attempts, submit the zero attempts form.
  4. Please fax forms to (971) 673-0990. Fax is confidential and secure.
Although fax forms are preferred, forms can be mailed to:
Adolescent Suicide Attempt Data System
Injury and Violence Prevention Program
800 NE Oregon Street, Suite 772
Portland, OR 97232
Note: The Injury and Violence Prevention Program does not provide postage-paid return envelopes.
Annual Data Reports

Additional reports and plans are posted on the Injury and Fatality Data State Plans and Reports page