Background The Veterans Health Administration (VHA) implemented REACH VET, which analyzes health records to identify veterans at statistically elevated risk for suicide and other adverse outcomes compared to other veterans in VHA. This project evaluated REACH VET program implementation at a large VA health care system by examining program fidelity and treatment engagement, receipt of suicide prevention interventions, and suicide-related behaviors in the 6 months following identification. Methods Over a 12-month period, 218 unique cases were identified by REACH VET within a local VA system. Data were extracted from the VA’s electronic medical records. Results Protocol adherence for required clinical and administrative steps was 94% and above. After identification, 88% received outpatient mental health treatment, 21% had a psychiatric hospitalization, and 83% engaged in Safety Planning around the time of identification or in the following six months. Twenty-six percent of cases were identified by another existing method for identifying high-risk veterans. Five percent had a medically documented suicide attempt, and none were known to die by suicide in the following 6 months. Conclusions Local evaluation suggested high protocol fidelity and high engagement in mental health and suicide prevention services following identification among veterans who remained at elevated risk in the 6 months that followed.