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LAFD Captain/Engineer > Forms > Flashcards

Forms Flashcards

1
Q

F-HMIF, PB-8

A

Hazardous Materials Form Direction
- Copies: 1
- Retained: 3 years
- Forward: Data Management Unit, Technical Section, FPB

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2
Q

Notice to Comply Form SD

A

Smoke Detector
- Copies: 4
- Retain: 3 years
- Enforcement: Building and Safety and LAFD
- Required: Occupancies containing 2 or more dwelling units

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3
Q

DWC Form 1

A

Claim Form
- Work Related injury/illness, Law requires employer to provide within 24 hrs of occurrence to injured member
- Copies: 5
- Retained: Indefinitely by members
- Forward: When member received treatment
- Document: F-2 when forwarding

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4
Q

F-2

A

Journal (Record of daily History)
- Retain: 1 year after the last entry
- Forward: To Manuals and Orders (Mail Stop 250)
- Identification: Inside front cover, station #, start date
- Red Ink: Date, Alarm, Emergency/Non-Emergency Move up as result of Alarm
- Green Ink: Pay roll Symbols
- Blue/Black Ink: All other entries

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5
Q

F-3

A

Hazardous Substance Exposure Report
- Copies: 2 (1) member, (1) MLU
- Forward: Medical Liaison Unit immediately following exposure

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6
Q

F-5

A

Daily Staffing Roster
- Copies: 1
- Retain: 90 days after calendar year
- BC Aid shall call stations prior to 2100 hours to ensure 5 day staffing

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7
Q

F-8

A

Roster Change
- Used to notify Personnel Services
- Copies: Print 1 for Civilians, 2 Uniformed members, 3 copies for Chief Officers
- Forward: 24 hours after any changes, through channels to Personnel Services
- Exception to Forwarding: Verbal notification by on duty Station Commander
- Changes: Underline in RED ink, but do not abbreviate
- Changes include: Residence, Phone #, Marital or Domestic Partner, legal name changes

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8
Q

F-9

A

Roster Card
- Roster retained at Battalion and Division
- Copy: 1
- Retain: Until separation from department
- Forward: Time of Transfer
- Routing: New Battalion and Division if applicable

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9
Q

F-10

A

Medical Exam Record
- 3”x5” preprinted card
- Copy: 1
- Retain: Until separation from department
- Forward: Time of transfer
- Routing: New Battalion and Division if applicable

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10
Q

F-11

A

Station Daily Roster
- Use the same symbols used in the F-5054s
- Retain: Discard after usefulness has passed

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11
Q

F-13

A

On/Off Duty Checklist
- Used to assure that all notifications and documentation is completed when a member either goes off duty or returns to duty
- Copies: 1
- Retain: Until Usefulness has passed

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12
Q

F-16

A

Vehicle Shop Numbers and Lock Box Assignment
- Completed at the end of each quarter
- Copies: 2
- Retain: 1 year
- Forward: No later than 5th day following quarter

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13
Q

F-17

A

Pay Grade Advancement Application for Premium Hazard Pay
- Copies: 1
- Retain: 1 year
- Routing: In January, forward to Personnel Services

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14
Q

F-18

A

Transfer of Uniform Personnel
- Used to notify City’s Controller of change of work location/payroll
- Copies: 1
- Retained: Personnel Services Indefinitely
- Routing: Through channels to Members Bureau Commander

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15
Q

F-18A

A

Request for Transfer
- Used for member to declare a desire for assignment
- Copies: 2
- Retained: End of Calendar year
- Routing: Original to Bureau, Duplicate back to member

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16
Q

F-18B

A

Request for Transfer Primary Vacancies
- Used for member to declare a desire for assignment
- Copies: 2
- Retained: End of Calendar year
- Routing: Original to Bureau, Duplicate back to member

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17
Q

F-20A

A

Evacuation Notice (English)
- Used during evacuations
- Copies: 1 per household

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18
Q

F-20B

A

Evacuation Notice (Spanish)
- Used during evacuations
- Copies: 1 per household

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19
Q

F-23

A

Emergency Overtime Report
- To apply for approval of 1 1/2 time in emergency hours worked, in 1/10 hour increments
- Copies: 3 (1) Bureau, (1) Accounting, (1) Station File
- Forward: Forward with 5054 no later than end of week in which overtime worked
- Routing: Account Services
- Retain: 2 years
- Includes: EOD and Court Time

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20
Q

F-26

A

Report of Administrative Overtime (AOD)
- Used to request AOD Overtime, while working voluntary OT at emergencies
- Copies: 3
- Retained: Original (Accounting Services)
- Retained: Duplicate, returned through channels to member
- Retained: Triplicate, with member until duplicate returned

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21
Q

F-41

A

Revision Report
- Used to recommend revision in the Manuals, Notify Planning
- Copies: 1
- Retain: Until Manual and Orders takes action
- Separate F-41 per recommendation

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22
Q

F-44

A

Intra-Departmental Memo
- Used by FPB or Field Officers for written communication between them
- Copies: 3
- Retain: 3 years
- Limit: Limited to 1 occupancy per F-44

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23
Q

DL 44C

A

Application for Commercial Drivers License
- Copies: 1
- Forward: To DMV with Forms DL-51 and DL-51A

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24
Q

F-49

A

Ordinance Leave
- Immediate Family due to illness/injury, Death and Preventative Medical
- Copies: 2
- Routing: Original to Accounting Services
- Forward: Upon return to duty
- Requested Hours: Enter to the nearest whole number

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25
Q

F-63

A

Fire Prevention Summary
- Copies: 2 by each shift commander
- Forward: Last working shift of the quarter no later than 5th day of following quarter
- Retain: 5 years in Station files
- City of San Fernando: Forward separate F-63 for Fire Prevention conducted in San Fernando

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26
Q

F-63A

A

Fire Prevention Activities
- Copies: 1
- Retain: 3 years in Book #55

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27
Q

F-63B

A

Daily Training and Fire Prevention Activities
- Copies: 1
- Retain: 3 years in Book #55
- Record hours to the nearest 1/4 hour

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28
Q

FG-68

A

Military Leave Compensation

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29
Q

F-70

A

Hydrant TEST Record
- Used by companies to record hydrant testing. To cover 5 hydrant tests per sheet
- Copies: 1
- Retain: In Hydrant Book, when completed put 1 year in file

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30
Q

F-79

A

Notice of Commendation
- Any supervisor in Chain of Command may complete
- Copies: 3
- Routing: Original returned to member AFTER Bureau approval
- Routing: Duplicate to Personnel Services
- Routing: Triplicate to Department of Personnel (City)

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31
Q

F-80

A

Store Requisition
- Copies: 3
- Retain: 3 months at assignment
- Retain: 3 years for Medical Supplies**
- Forward: 2 copies to the concerned Department.
- Maintain 1 copy in members/stations folder

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32
Q

Form General 84B

A

Witness Card
- Completed by NON- city employee who witnesses onscene of accident
- Copies: 1
- Retain: Permanently
- Forward: with FG-88 (Accident Report)

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33
Q

F-85

A

Request for Legal Ownership
- Used to determine owner of property when siting FP violations
- Copies: 2 (1) Legal and (1) Station file with F-173 (Occupancy Record)
- Retained: 5 years
- Forward: Legal Liaison, FPB

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34
Q

Form General 88

A

Accident Report
- Prepared when accident causes damage to property or bodily injury
- Copies: 5
- Retain: Permanently
- Forward: Within 24 hours to Bureau through channels then forwarded to Personnel Services

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35
Q

F-95

A

Fire Hydrant RECORD
- To keep record of fire hydrants, 1 hydrant per line*
- Copies: 2 (1) Hydrant Book and (1) FPB
- Retain: Permanently
- Forward: When new pages are required by FPB Hydrant Unit

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36
Q

F-100

A

Suggestion Form
- To suggest new methods or procedures
- Copies: 1
- Retain: 5 years in Planning Section

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37
Q

F-101

A

Emergency Activity Report- Personnel
- Used to document use of Personnel and Equipment at all MAJOR Incidents (Earthquake, Floods, Civil Disturbance)
- Copies: 2
- Routing: Management Services Section and retain duplicate in Station File

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38
Q

F-101

A

Emergency Activity Report W/ Multiple
- Multiple F-101s
- Used to document responses at Major Emergencies
- Copies: 2
- Routing: Management Services, duplicate Station file

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39
Q

F-113

A

Analysis of Emergency Operations
- Used on all Major Emergencies or as directed
- Copies: 3 (1) ESB, (1) FPB, (1) Training
- Routing: Through channels to Bureau

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40
Q

Form General 113

A

Request Station Repair/Maintenance
- Detailed information on request of repairs/maintenance
- Copies: 2
- Routing: Building Administration
- Entries: Type all entries
- Retain: Until usefulness has passed

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41
Q

F-121

A

Hose Inventory Record
- To record date hose was issued
- Copy: 1
- Retain: Until usefulness has passed in Book #55
** Hose expected life is 10 years (*AOTM states: 5 years)

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42
Q

F-122

A

Hose and Salvage Cover Overlay
- Copy: 1
- Retain: Book #55
- Used: Use in conjunction with F-128 (Hose/Salvage Cover Record)
- Use both sides of Form (Hose section numbers and salvage cover numbers)

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43
Q

F-126

A

Bed and Locker Assignment Record
- Copy: 1
- Retain: Book #55

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44
Q

F-128

A

Hose and Salvage Cover Record
- Kept in Book #55
- Copies: 1
- Retain: 6 months
- Used: Using in conjunction with F-122 (Hose and Salvage Cover Overlay)

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45
Q

F-129

A

Annual Hose Test Record
- Copies: 2
- Routing: 1 copy to Equipment Engineering
- Retain: Book #55
- Sign: Only 1 officer signs

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46
Q

F-150

A

Accident Report- Investigating Officer
- Copies: 1
- Forward: After obtaining all reports (F-225, Form General 88, Form General 84)
- Routing: Bureau Commander
- Retain: 1 year at Personnel Services

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47
Q

F-151

A

Accident Report Procedures
- Retain: F-620 (Accident Packet)
- Used: As a procedural guide

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48
Q

F-161

A

Authorization for Delivery of Unpaid Salary Check
- Copy: 1
- Retain: Until Action completed or renewal filed
- Authorize Payroll to mail check after retirement or separation
- Paychecks not picked up by members by next assigned platoon duty shift with no F-161 on file- Commander return to payroll

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49
Q

F-165

A

Duty Certificate
- Used to report Return to Duty Status on all leaves when member was scheduled to be at work on duty
- Copies: 2 for NIOD, 3 copies for IOD (1 copy civilian)
- Medical Treatment: When F-1001 is required, staple F-165 and forward both
- Use: For IOD and NIOD
- Additional Leave use: Military, Civil Service, Disciplinary, Special

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50
Q

F-166A

A

IOD Illness or Injury Report
* Discontinued
- Replaced by F-5020

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51
Q

F-166B

A

NIOD Report
- Any NIOD illness/injury, includes SOD shift which is working responsibility
- Copies: 2
- Forward: 1 copy within 24 hours
- Routing: Medical Liaison Unit
- No Code-A-Phone required when going off duty
- Time Documented: Use 24 hour clock

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52
Q

DL 170

A

Certificate of Driving
- For original issue of Class “B” or “A” license, or change “B” to “A”
- Used if current license expires more than 6 months ago
+ For Original Passenger Endorsement:
- Copies: 2
- Orignal Copy: DMV
- Routing: In service training through channels
- Driving Courses: FS 3, FS 40, and FS 88

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53
Q

F-173

A

Occupancy Record
- Used to indicate General Occupancies
- Copy: 1
- Retain: 3 years

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54
Q

F-173A

A
  • Occupancy Record, FPB
  • Used to indicate FPB Occupancies
  • Copy: 1
  • Retain: 3 years
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55
Q

F-175 Tag

A

Material to Storeroom Tag
- Attach to article
- Print Legibly

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56
Q

F-211

A

Citation
- The act of a misdemeanor must be witnessed by the person issuing the citation. List specific code section violated and print a short description of offense.
- Instructions: Members shall conform to the instructions appearing on the INSIDE cover of the Citation Book
- Copies: 4
- Retain: 3 years

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57
Q

F-215

A

Equipment Loan Receipt
- Use when leaving equipment at the scene
- Copies: 2
- Retain: Until returned

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58
Q

F-215M

A

RESCUE Equipment Loan Receipt
- Use when lending Equipment at Medical Facilities
- Copies: 2
- Retain: 72 hours MAX, or when equipment is returned
- Forward: With F-225 through channels when equipment is LOST

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59
Q

F-223

A

Intra-Departmental Correspondence Red Letterhead WITHOUT Boxes
- Used when a formal report is needed and no other form is provided, and when routing through channels is NOT desired
- * Volume 5 has form down as F-233 (typo)
- Retain: 1 year or until usefulness has passed
- Through Channels: Addressed to the highest office
- Sign: Signed by the originator on the last page
- Font: Aerial 12, may use 11 to conserve space
- Margin: 1”
+Format
- Date:
- To:
- From:
- Subject: All Capitals with ATRS# (Assignment Tracking Report System #)
- Summary
- Recommendation
- Findings
- Conclusion

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60
Q

F-225

A

Intra-Departmental Correspondence Red Letterhead WITH Boxes
- Used when a formal report is needed and no other form is provided
- Retain: 1 year or until usefulness has passed
- Through Channels: Addressed to the highest office
- Sign: Signed by the originator on the last page
- Font: Aerial 12, may use 11 to conserve space
- Side Margin: 1”
+ Format
- Date:
- To: When going through channels use Capitals
- From:
- Subject: All capitals with ATRS# (Assignment Tracking Report System #)
- Summary
- Recommendation
- Findings
- Conclusion

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61
Q

F-226A

A

Informal Grievance Discussion
- Initiated by Immediate Supervisor, to document informal discussion
- Copies: 1
- Forward: ASAP
- Routing: Department Management Representative, through channels
- Delivery: Officer personally delivers without delay, through channels and filed in the grievance file
- Note: Member has 15 calendar days to file FORMAL Grievance.

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62
Q

F-226B

A

Formal Grievance
- Initiated by Grievance to request review of a grievance at all formal levels
- Copies: 5
- Forward: Within 10 calendar days from the date (*MOU says 15 days)
- Routing: 4 copies to Department Management Representatives

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63
Q

F-226C

A

Reply to Statement of Grievance
- Initiated by the Grievance reviewer to reply to an F-226B (Formal Grievance)
- Copies: 5
- Forward: Within 15 days (NOT calendar days like for “A” and “B”) from the time the F-226B was received in Battalion. Form will be time stamped by Department Representative
- Delivery: Hand delivered in person or by Registered mail
- Fire Commission Review: 21 days

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64
Q

F-228

A

Fire Department BLACK Letter Head
- Correspondence to Government Agencies, Organizations, Businesses and the General public for letters of appreciation
- Sign: Signed by the originator on the last page
- Font: Aerial 12, may use 11 to conserve space
- Side Margin: 1”
- Closing: “Sincerely” is used
- Signature Boxes: Fire Chief, but originator signs

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65
Q

F-250

A

Weekly Bulletin
- Initiated by the Fire Chief. Announcement published 1 time, twice for class reunions or retirement dinners
- Retain: 1 year
- Size: 8 1/2” x 11”
* One of three parts in library that supersede MOPS: BNR-Weekly Bulletins, Special Notices, Rules and Regs

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66
Q

F-280

A

Division 5 Permit
- Copy: 1
- Forward: To FPB Environmental Unit
- Retain: Indefinately

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67
Q

F-290

A

Request for Legal Action
- Used to summarize information needed for prosecution of a case
- Copy: 2
- Retain: 5 years
- Routing: Legal Liason

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68
Q

F-295

A

Hazardous Material Shipping Paper
- Copy: 1
- Remain: With transport apparatus

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69
Q

F-315

A

Special Permit
- Issued for open outdoor fires
- Copies: 3
- Expiration: No longer than 1 year or usefulness has passed

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70
Q

F-334

A

Complaint of Hazard
- To record Citizen Complaints
- Copies: 1
- Filed: File in Complaint Book
- Retain: As long as of value
- Council Complaints: RED ink
+ F-334 Posting
- Other than Mountain Fire District: Issue F-340A (Fire Life Safety Violation). Document posting of F-335A (Notice to Abate Public Nuisance and Fire Hazard) on back of F-340A with signature and date.
- Mountain Fire Districts, Fire Buffer Zones, Mt. Washington: Post F-1308A (Notice of Non-Compliance) 4th copy

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71
Q

F-335A

A

Notice to Abate Public Nuisance and Fire Hazard
- Used to notify owners of property of violation
- Copy: 1 in a conspicuous location on premises
+ Posting
- Other than Mountain Fire District: Issue F-340A (Fire Life Safety Violation). Document posting one F-335A on back of F-340A with signature and date
- Mountain Fire Districts, Fire Buffer Zones, Mt. Washington: Post F-1308A (Notice of Non-Compliance) 4th copy

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72
Q

F-336

A

Condemnation Tag (RED Tag)
- Used in condemning appliances or Equipment pursuant to the authority of the Chief
- Copy: 1
- Posting: Attach to appliance or device
- Use: Ink

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73
Q

F-337

A

Notice of Re-Inspection
- Used by Fire Companies
- Routing: Left at scene of re-inspection or at scene of an incident

74
Q

F-338

A

Interdepartmental Referral (PINK)
- Used to direct violations of LA Municipal Code to Responsible Department
- Copies: 2, type or clearly print
- Retain: 3 years
- Routing: Original Pink to Department
- YELLOW duplicate into pending file
- Vacant Structures: Unsecured structures, forward with F-340A (Fire Life Safety Violation)
- Lot Cleaning: Mail Stop 550
- Nuisance Abatement: Mail 115 (Building and Safety)

75
Q

F-339

A

Posting Hazardous Building
- Used with Notice to serve as warning of Fire, Explosion or Hazard
- Copy: 1
- Routing: On exterior of Premise

76
Q

F-340, A,B,C,E,FW

A

Fire Life Safety Violation
- Copies: 340A and B (3 copies), 340 C and E (2 copies)
- Retain: 3 years
- Vacant Lots: Do NOT issue on Vacant lots
- Re-inspect: Shall NOT be over 30 days of issue
- Routing: Citizens. If Municipally, forward to Legal Liaison
- Legal Action: Note of F-173 (Occupancy Record)
- Major Progress Extension: 15 additional days may be granted
* A: General Fire Life Safety
* B: Exits/Blocked Door/Signs
* C: Blank
* E: Overcrowding
* FW: Fire Watch

77
Q

F-340D

A

Fire Protection Performance Certification
- Used to inform owner of required testing, maintenance and repair
- Copies: 4
- Retain: 5 years
- Routing: 1st, 2nd, and 3rd to Owner, 4th in station file
- Test: Within 30 days
- Repairs and Retest: Within 30 days

78
Q

F-341

A

Noncompliance Fee Form
- Utilized to initiate billing of a business or occupancy for re-inspections due to being non-compliant
- Copies: 2
- Retained: Legal Liaison for 3 years
- Retained Accounting: Permanently

79
Q

F-351

A

Time Record
- Used to maintain an Annual Record of Vacations, Holidays, Trades, and FLSA
- Copy: 1
- Retain: In Book #55 until calendar year END
- Retain Copies: 3 years
- Forward: Accounting Section within 10 days of years END, or separation from Department
- 126 Day Cycle: Used when member transfers to new assignement
- 8-Hour Schedule: Member will use 1 full platoon duty day (12 hrs) for each 8 hr day taken off detail duty
- 9-Hour Schedule: Member will use 1 1/8 platoon duty day (13.5 hrs) for each day taken off detail duty
- 10-Hour Schedule: Members will use 1 1/4 platoon duty day (15 hrs) for each 10-day taken off detail duty

80
Q

F-351A

A

Time Record Worksheet
- Used with F-351 (Time Record)
- Copy: 1
- Retain: In Book #55 until calendar year END
- Retain Copies: 3 years
- Forward: Accounting section within 10 days of years END, or separation from Department.
- Symbols: The same used on F-5054
- FLSA Hours: All time required to be on the employer’s premises on duty or at a prescribed workplace. Actual court appearances, not for stand by hours. Traded time taken off is recorded in the shades boxes as FLSA hrs worked.

81
Q

F-360

A

Adjustment of Platoon Duty (Trades)
- For exchange of maximum of 1 full shift
- Copies: 2
- Retain: End of calendar year
- Routing: To commander for approval, than in members file
- Approval: Upon approval, make entries in F-351
- Sign: Both members shall sign

82
Q

F-361

A

Request Time Off or Vacation Time
- Copies: 1
- Retain: AOD and TS until end of PAY PERIOD
- Retain: Vacation and Holiday until end of calendar year
- Routing: Member’s folder
- Thanksgiving, Christmas Eve and Christmas Day: At least 9 days but not more than 60 days prior to leave, HOLIDAY: within 5 days or less
- TS Trade: Underline Statement in RED Ink

83
Q

F-366

A

Private Hydrant Report
- Used to notify Stations of private hydrant installation and type of system connected.
- Copies: 2 (1) Hydrant Unit and (1) Company
- File: File in Hydrant Test Book

84
Q

F-367

A

Fire Hydrant Report
- Sent to stations when installed, enlarged, relocated or removed.
- Copies: 2 (1) Maps and Drafting and (1) Hydrant Unit
- Forward: To Hydrant Unit within 14 days of receipt

85
Q

F-370

A

Record of Drivers Training
- To document individual drivers training activity for “A” and “B” License
- Copies: 2 (1) In- Service and (1) Personal folder at work location
- Retain: Indefinitely in member’s folder and In-Service

86
Q

F-377

A

Bi-Monthly Inspection
- To document preventative maintenance of apparatus
- Copies: 2
- Retain: Last 6 copies in Log Book
- Completed: Engineers, Apparatus Operators and responsible members
- Forward: 1 copy to BC within first 2 weeks of appropriate month. Copy to arrive no later than day before inspection or 15th
- Signature: Station Commander/Unit Commander initial
- F-80: Must forward F-80 with repairs along with F-377 to BC
* Heavy Apparatus (Front line/Relief): February, April, June, August, October, December (EVEN months)
* Light Apparatus (Front line/Relief): January, March, May, July, September, November (ODD months)
* Reserve Apparatus: Every 4 months

87
Q

F-377 RA

A

Bi-Monthly Inspection Rescue
- Copies: 2
- Retain: Last 12 copies

88
Q

F-380

A

Apparatus Yearly Mileage
- To record miles driven in Fiscal Year and total miles of vehicle
- Copies: 2
- Retain: 1 year
- Forward: S&M by 10 days after fiscal year
- Transfer: Last F-380 myst be forwarded with Logbook

89
Q

F-392

A

Fuel Usage Report
- Reflects all Fuel consumed during pumping, Aerial and All off Highway miles
- Copies: 2
- Forward: Account Services, no later than 5 days after end of each MONTH.

90
Q

F-393

A

Training Activity Record
- Copies: 1
- Retain: Indefinitely in Members Folder
- Haz Mat Entries: In GREEN ink

91
Q

F-398

A

Weekly Crew Time Sheet (Correction)
- Used to make changes on Weekly Time Sheets (5054s)
- Copies: 2
- Forward: Both copies to Account Services Section
- Return: Returned from Accounting, put in personal folder
- Approve: Supervisor, Members shall not approve own timekeeping

92
Q

F-398A

A

FLSA Crew Time Sheet (Correction)
- Copies: 2
- Forward: Both copies to Account Services Section
- Return: Returned from accounting into personal folder

93
Q

F-398C

A

FLSA after 40 Crew Time Sheet (Correction)
- Copies: 2
- Forward: Both copies to Account Services Section
- Return: Returned from accounting to personal folder

94
Q

F-400

A

Community Directory
- Copy: 1
- Retain: Book #20 Public Affairs

95
Q

F-420

A

Communicable Disease Exposure and Notification Report
- Notifies staff at Receiving Facilities, LAFD may have been exposed
- Copies: 3
- Forward: Original Medical Facility, 2nd Medical Liaison Unit Immediately, 3rd Employee
- Completed: By member at the time of exposure
- Confidential: Only release to those persons directly involved in follow up care

96
Q

F-526

A

Duplicating Services (Making Copies)
- Copy: 1
- Retained: Manual and Orders until usefulness

97
Q

F-527

A

Occupant Load Sign
- To request Occupant Sign from Maps and Drafting
- Copy: 2
- Sign numbers and letters NOT less than 1/2” in height

98
Q

F-579

A

Correction Needed to F-580 (Overtime Report)
- Initiated by: Station Commander
- Copies: 2 (2) Accounting Services, (1) copy returned after correction made
- Routing: Account Services

99
Q

F-580

A

Overtime Report
- Record of members accumulated overtime
- Summarized: Report send to station every 6 months
- Copies: 2 (1) Accounting and (1) Company Headquarters
- Retain: Last 2 summaries

100
Q

F-590

A

Record of Overtime Card
- Used to keep record of all numbers charged when a member works overtime
- Copy: 1 per member
- Retain: 90 days
- Complete: Each time member works overtime
- NOTE: Volume 5, F-590 instructions include details for the hiring of Overtime

101
Q

F-591

A

Station SOD Request Record
- Used to keep record of members request to participate in working SOD
- Retain: 90 days

102
Q

F-592

A

SOD Notification
- Used as a reminder, members scheduled to work SOD
- Retain: Until usefulness has passed

103
Q

F-620

A

Accident Packet
- Retain: Permanently in Department Vehicles and 2 spares in station
- Forms in Packet: Form General 84B, Form General 88, F-150, F-151

104
Q

F-665

A

Large Scale Emergency Package
- Carried on ALL emergency vehicles
- ICS breakdown
- Worksheets

105
Q

F-666

A

Resource and Situation Status Record
+ Two-Sided Form:
1. Multi-story/High Rise/Ship Incident
2. Brush or 1 story incidents
- Retain: Place of origin
- ENR Column: Best to split (list) TF separately as “E” and “T”

106
Q

F-666A and B

A

Resource and Situation Status Record
- Normally used by DIVISION Commanders
+ Two Sided Form
1. F-666A Multi Story
2. F-666B Single Level Incidents
- Marking: Can use a check mark, an X or the time as appropriate

107
Q

F-666C

A

Hazard Material Incident Data Sheet
- Forward: With F-902 and F-113 as needed
- Routing: Through channels to Research Unit with F-902 and F-113
- 7 Page Report: 7 page check off package is provided in each Haz Mat unit
- Mobile Labs: Carries 12 copies
- Ordering: Manual and Orders

108
Q

F-666E

A

Multi-Patient Incident Worksheet
- Initiated by 1st on scene EMS or Fire Resources
- Carried: Carried on ALL Paramedic units and SOME Fire Units

109
Q

F-666 S&T

A

Strike & Tactical Teams
- Form: Consist of 2 sheets
- F-666S: Tracking Formation and Deployment of Strike Teams
- F-666T: Tracking Formation and Deployment of Tactical Teams

110
Q

F-673

A

Paramedic Worksheet
- Copies: 1
- Forward: ER with patient
- Records: times, dosages, and drugs administered

111
Q

F-701

A

Statistical Information
- Retain: Log Book
- Copies: 2 (1) Logbook & (1) S&M

112
Q

F-702

A

Assignment Record
- Retain: Log Book
- When transferred or detailed, OFFICER will check inventory

113
Q

F-704

A

Maintenance Record
- To keep records of maintenance and Lube records
- Copies: 1
- Retain: Last 6 copies

114
Q

F-705

A

Repair Record
- Retain: Log Book
- Retain: Permanently in Log Book

115
Q

F-706

A

Battery Record
- Copies: 1
- Discard: When completely filled

116
Q

F-709

A

Firefighting Inventory Record
- Retain: In Log Book

117
Q

F-710

A

Tire Record
- Copies: 1
- Retain: Permanently in Log Book

118
Q

F-725 to F-745

A

Found in PRB

119
Q

F-725

A

Personnel Record Book Table of Contents

120
Q

F-726

A

Personal Record

121
Q

F-726A

A

Notification Record

122
Q

F-727

A

Address-Phone

123
Q

F-728

A

Evaluation

124
Q

F-729

A

Assignments

125
Q

F-730

A

Details

126
Q

F-731

A

Driver License

127
Q

F-732

A

Training

128
Q

F-733

A

Medical Fitness & Immunization

129
Q

F-734

A

Illness or Injury, Continued Duty Form

130
Q

F-735

A

Leaves

131
Q

F-736

A

Protective Equipment Record

132
Q

F-737

A

Education, Colleges

133
Q

F-741

A

Probationary Record Chart- Orientation

134
Q

F-743

A

Medical Training Record Probationary

135
Q

F-745

A

Hazardous Substance/Communicable Disease Exposure Record

136
Q

F-863

A

Barbecue Permit
- Copy: 2
- Retain: 1 month after expiration of F-315 (Special Permit)
- Issued: Person concerned attached to F-315
- F-315: Issued to schools, churches, day nurseries

137
Q

F-902

A

Field Incident Report
- Copy: 1
- Retain: 5 years by ARSON
- Reference: Field Incident Code Book
- Routing: Information System Unit

138
Q

F-902M

A

Medical Report
- Copy: 4
- Retain: 10 to 20 years by the Department
- Forward: Per EMS Instructions (Book#5)

139
Q

F-903

A

Controlled Medication Inventory Record
- Initiated by Paramedics and EMS Captains
- Copies: 1
- Retain: 3 years
- Reference: Book #33 (Pre-hospital Care Policy Handbook) and Reference 702 and 717
+ Shall be completed:
1. Shift Change
2. Personnel Change
2. Inventory Change

140
Q

F-904

A

Situation Report
- For inquiries and feedback: Will assist Department with incidents, policies, practices and procedures. Identify system trends
- Copies: 3, type or print
- Retain: 1 year
- Routing: Through channels to EMS Captain by END of shift
- Routing Duplicate: Quality Improvement Section (QIS)
- Tablet Format: Available at S&M

141
Q

F-916A & F-916B

A

Request Photo Services & Audio Duplicate
- No forms are required when request services, just PHONE
- Copies: 3 needed for Photographer
- Routing: Original to Photo Video

142
Q

F-955

A

Information Pamphlet “What to do after a Fire.”
- Issued to owner or post in building
* 1 per dwelling unit
* Adequate supplies of these forms are to be carried on ALL Fire companies and Chief officer’s sedans
* Causes and origin of the fire may be discussed UNLESS it is:
1. Incendiary
2. Suspicious
3. Under investigation
4. Involves Juveniles
5. Fatalities
6. Serious Burns
* In the cases listed above, questions about cause should be referred to Arson Investigation Section.

143
Q

F-957

A

Company Activity Schedule
- Monthly schedule of activities, by Platoon
- Copies: 2 (1) Station & (1) Battalion
- Retain: Duplicate 1 year
- Routing: To BC at least 5 days prior to start of month
- Fire Prevention “Re-Inspection”: Note on F-957

144
Q

F-971

A

Community Relation Activity Report
- Used when a Group, Church, Boy Scout or School visits Fire Station
- Copies: 1
- Retain: 1 year by DIVISION
- Neighbor Visit: NO need to report for neighborly visits

145
Q

F-972

A

Daily Pre-Trip Inspection Record
- Used by members responsible for Heavy apparatus checks
- Copies: 1
- Retain: 1 month after last entry in Log Book

146
Q

F-973M & F-973W

A

Apparatus/Equipment Check Record
- Weekly and Monthly Check Record
- Copies: 1
- Retain: 1 month after last entry, in Book #55

147
Q

F-974

A

Reserve Apparatus Condition and Inventory Record
- Copies: 1
- Retain: Log Book 1 year from last entry

148
Q

F-975

A

Lifeline/Rescue Kit
- Document the date of issue, usage, and monthly inspection of kit
- Enter: 1 operation PER line
- Retain in Book #55

149
Q

F-976

A

Annual Ground Ladder Inspection Record
- Copies: 1
- Retained: In Log Book
- Forward: To S&M when ladder is removed from service

150
Q

F-977

A

Apparatus Inspection Checklist
- Used by Company Commander and BC to document Bi-Monthly inspection of apparatus.
- Copies: 1
- Retained: 3 years in Log Book
- Signature: BC and company commander

151
Q

F-978A

A

Heavy Apparatus Undercarriage Inspection CHECKLIST
- Used by Company Commander and Battalion Commanders to document 4 month inspection of apparatus undercarriage
- Copies: 1
- Retain: 3 years in Log Book
- Signature: BC and Company Commander

152
Q

F-978B

A

Heavy Apparatus Undercarriage Inspection RECORD
- Used by BC to document 4 month inspection of apparatus undercarriage
- Copies: 2, (1) to S&M, (1) Log Book
- Retain: Per F-978 form 1 year in Log Book (*Volume 5 states: 3 years)
- Only BC Signs

153
Q

F-979

A

SCBA Inspection Checklist
- Used by Company commanders and BC to document the Bi-MONTHLY inspection of SCBAs
- Copies: 1
- Retain: 3 years in Book #55
- Signature: BC and Company Commander

154
Q

F-1000

A

Work Compensation, IOD, Dr. Recommendations Status, 1st Care Follow Up
- To provide Dr with checklist of Duty Status Recommendations
- Copies: 1
- Retain: MLU Indefinitely
- Forward: To MLU immediately following IOD Dr. appointment

155
Q

F-1001

A

Dr. Work Status, Limitation Notification Report
- Used to establish proof of illness or disability
- Copy: 1
- Forward: MLU
- Retain: Indefinitely

156
Q

F-1104

A

Notice to Improve
+Deficiency observed In:
1. Appearance
2. Attitude
3. Work Habits
4. Performance
5. Actions
- Any supervisor within member’s chain of command with direct knowledge may issue to secure correction of deficiency.
- Copies: 3
- Retain: Until deficiency corrected or permanently
- Routing: 1 to member, 1 to officer, members Bureau Commander
+ Signature:
1. Member must sign copies but signature does not denote concurrence, or non-concurrence
2. If member refuses to sign the document, the issuing supervisor shall sign the document in member’s presence (with date and time) documenting the member’s refusal
- Check box: Check either, “concur” or “Do not concur”
+ Deficiency CORRECTED
1. When corrected, and in no case longer than 6 months from the date of issue, the member’s immediate supervisor shall indicate so on both the FIRST and SECOND copy.
2. Member’s immediate supervisor shall forward the SECOND copy through channels to the member’s Bureau Commander.
3. Once Bureau receives the SECOND copy, the member’s Bureau Commander shall return SECOND and THIRD copies to member.
+ Deficiency NOT Corrected
1. Additional notices may be used
2. Supervisor may enter in the Complaint Tracking System (CTS) however, the notices themselves shall NOT be attached to the complaint.

157
Q

F-1105

A

Reprimand
- Used in cases of Serious or repeated violations that necessitate appropriate action and proper documentation.
+ Investigation:
1. All reprimands shall be written by PSD IF, after a complete investigation, including any mitigation factors, PSD determines that a Reprimand is the most appropriate course of action.
2. PSD will email Reprimand to the member’s Bureau Commander for forwarding through channels to member’s immediate supervisor.
- Initiated by: PSD
- Copies: 3 (1) member, (1) PSD, (1) Members Personnel Folder at Personnel Services Section
- Immediate supervisor signs all THREE copies and return 2 copies to immediate supervisor.
- Supervisor forwards to PSD without delay
- Employee Representative: Member may have a rep present during issuance
- Signature: member must sign and date and indicate concurrence or non-concurrence
- If member refuses to sign the document, the issuing supervisor shall sign the document in member’s presence (with date and time), documenting member’s refusal to sign.
+ Non-Concurrence
1. Per FF Bill of Rights, a member may request an administrative appeal (Grievance) challenging the Reprimand.
2. The 15 day calendar day period (Step 1) of Grievance begins on day FOLLOWING the day Reprimand was presented to member.
3. During the period of time in which the appeal is proceeding through the Grievance procedure, the 2 originals of the Reprimand shall be retained by PSD.
4. If the appeal is APPROVED, the 2 originals shall be returned to the member.
5. If the members’ appeal is DENIED, the member shall have 30 calendar days to file a written response to the Reprimand. The written response shall be attached to, and shall accompany, the Reprimand into the member’s personnel file.
- Retain: permanently in member’s folder at Personnel services
- Routing: (1) member, (1) officer, (1) PSD then forwarded to Personnel Services

158
Q

F-1109A

A

Visitor Waiver
- Sign prior to use of facility or equipment
- Copies: 2 (1) Visitor, (1) to BC to Public Service Unit
- Retain: 1 year
- Forward: BC then to Public Service Unit

159
Q

F-1109B

A

Indemnity Agreement
- Used before visitor uses Facility/Equipment NOT employed by City that may cause injury
- Copies: 2 (1) Visitor, (1) BC then to Public Service Unit
- Retain: 1 year
- Forward: BC then to Public Service Unit

160
Q

F-1109C

A

News Release Endorsement
- Prepared by Office before releasing material or equipment
- Copies: 2 (1) Applicant, (1) Public Service Unit
- Forward: Administrative Office to Public Services

161
Q

F-1117

A

Notice of Promotion Notice
- Copies: 2 (1) member promoted, (1) Headquarters personnel folder

162
Q

F-1122

A

Performance Evaluation
- To record Employee Performance of Duties
- Copies: 1
- Retain: Permanently
- Routing: Personnel Services Section
- Copy: Given to employee at the time of Evaluation
- Non-Concurrence: Member has 30 days
- Unsat: Rater F-225 to Bureau Commander attached to F-1122

163
Q

F-1132

A

Officer Evaluation
- Officer evaluation
- Same as F-1122

164
Q

F-1142*** NOTE

A

Probationary Firefighter Evaluation Forms
- ***All F-1142 forms in Volume 5 are incorrect per current department policy but this is wha the portal states as of June 10, 2017.

165
Q

F-1142

A

Probationary Firefighter 10 Shift Evaluation
- Copies: 4
- Retain: Original, permanently at Personnel
- Retain: 5 years at Recruit Training
- Routing: Originals at Batt unil 10 MONTH, than Personnel, through channels.
- Below Standard: Must have specific comment made in comment section
- Over All employee rating: Unsatisfactory, must make comment
- Primary Rater: The Station Commander
- Categories: 32

166
Q

F-1142A

A

Daily Probationary Report
- Completed each shift and reviewed with probationary firefighters
- Copies: 3
- Forward: With 10 Shift Evaluation
- Retain: 5 years at Recruit Training

167
Q

F-1142C

A

Probationary Performance Log
- Used to maintain Record of daily reports
- Copies: 3
- Forward: with 10 Shift Evaluation
- Retain: 5 years at Recruit Training

168
Q

F-1150

A

Outside Employment Report
_ * Request for Outside Employment
- Copies: 2 (1) members folder, (1) Personnel
- Routing Original: Through channels to Fire Chief
- Routing Annual Update: Through channels to ERO
- Disapproval: Officer attaches and forwards F-225

169
Q

F-1202

A

Weight Control Report
- Copy: 1
- Forward: Members Dr. or Batt, forward MONTHLY, First working shift of month.
- Routing: MLU

170
Q

F-1307

A

Cleaned by Owner
- Brush Clearance Form used to document COMPLIANCE
- Copies: 3
- Retain: 3 years at Station, 5 years at Brush Unit
- Forward: Within 24 hours after entry on the F-1308

171
Q

F-1308

A

Brush Clearance Notice of NON-Compliance
- For Improved/Unimproved Properties (Mt Fire District/Mt Washington)
- Used for weeds and grass on improved properties ONLY outside of these areas.
- Copies: 4
- Retain: 3 years at Station, 5 years at Brush Clearance

172
Q

F-1309

A

Brush Clearance Information Sheet
- Distributed to citizens, assigned to Brush Area. May be mailed.

173
Q

NOTE: F-3000, F-3001, and F-3002

A

Alcohol/Substance Abuse Forms

174
Q

F-3000

A

Employee’s Physical Characteristics/Behavior
- Issued by Supervisor with F-225 attached

175
Q

F-3001

A

Order for Urine Sample
- Issued: PSD to member with Union Representative

176
Q

F-3002

A

Employee Voluntary Urine Sample
- Issued: PSD to member with Union Representative

177
Q

F-5054

A

Weekly Time Sheet Overtime and Exception Report
- Copies:2
- Retain: 2 years
- Forward: Through channels to headquarters every SUNDAY
- Pay Period: Begins and Ends at 0800 hrs every OTHER Sunday
- Weekly Reporting: Begins and Ends at 0800 every Sunday
- Entries: Entries made at station where the member’s name is preprinted on 5054s
-* Do NOT line out or write members name because of transfer
- Not Working: Make entries whenever member’s is not working regular assigned hours or when member is on light duty
+ No Entry on 5054:
1. Holiday working or taking off
2. Administrative Time Off
3. Administrative Details
4. Trades

178
Q

F-5054A

A

FLSA Overtime Report
- Copies: 2
- Retain: 3 years
- Forward: To Accounting end of FLSA period, when transferring to special duty or vice versa

179
Q

Cal OSHA 200

A
  • Used for employee ANNUAL log and summary of Cal OSHA Recordable occupational injuries and illnesses
  • Complete: January following calendar year
  • Copies: 2
  • Retain: 5 years after end of calendar year
  • Forward: Duplicate to Occupational Safety Officer
  • Post on Official Business Bulletin Board: No later than February 1 and shall remain in place until March 1
  • NOTE: 24 hrs equals 2 work days (12 hrs each)
180
Q

Cal OSHA 300

A

Annual Summary of Work Related Injuries and Illnesses
- Post new calendar year Cal OSHA 300 every February 1 to April 30th on the Department Official Bulletin Board
- Must complete form even if no injuries occurred during calendar year
- If no cases of injury, Enter “0”

LAFD Captain/Engineer (31 decks)

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