FORMS

Question 1

Memorandum

Answer 1

Addresses city employees, notifies them of internal changes, specific problems/solutions, or events. Memo template found on workvivo, if numbered memo…filed indefinitely

Question 2

Community Engagement Request

Answer 2

Used to coordinate station tours, community events, school visits etc. Found on city website, fire page, resources tab, if no access to internet we may fill out for them, FD staff will follow up, BC will notify other BCs, tracked through BC teams page

Question 3

PACE

Answer 3

Performance and coaching excellence, done during probationary period and 1 time annually past probation, supervisors notified through workday, forms found on workvivo, employee does input form, supervisor does development plan, saved on workday profile

Question 4

Reimbursement Request

Answer 4

Must have verbal approval from supervisor prior to purchase, <$50 = petty cash, fill out form and submit to office specialist

> $50 = reimbursed via check, send email to office specialist with info, amounts, purpose of purchase, and scanned receipt

> $500 require Finance Executive Director approval prior

Petty cash slip found at stations and in admin

Question 5

What form do we fill out following a community event?

Answer 5

Community Engagement Survey, done by Captain

Question 6

Which sections of exposure documentation report do we do?

Answer 6

A and B

Question 7

Who is contacted regarding exposures?

Answer 7

BC and DICO

Question 8

Narcotic Discrepancy Memo

Answer 8

Completed when discrepancy is found (late check, missing, miscount)
Notify BC and EMS captain
Form found on policy, fill out, forward to EMS captain and BC, file in PSTrax, then perform narc check

Question 9

Adult Abuse

Answer 9

APS report on iPad, done ASAP but within 48 hours, notify EMS captain or EMS nurse, seamless doc on iPad uploaded, follow up with a phone call, do not attach to epcr

Question 10

Child Abuse

Answer 10

CPS report done on iPad, fill out ASAP but within 36 hours, notify CPS/EMS bureau/EMS captain or nurse/PD if danger, follow up phone call, do not attach to EMS report

Question 11

Sharps Log Injury

Answer 11

Anytime sharps injury occurs, notify BC and DICO, utilize infection control kit, forward form to DICO ASAP, only complete exposure paperwork if necessary (blood borne pathogens)

Question 12

Submersion Incident Report

Answer 12

Any water related incident involving children (even no transport), notify EMS bureau, seamless doc on iPad, forwarded to Safe Kids Inland Empire

Question 13

CAL OSHA

Answer 13

Used for serious injury, illness, or death of employee in place of employment or in connection with employment. Seamless doc on iPad, notify EMS captain, follow up phone call to OSHA within 24 hours of the incident

Question 14

Property Damage Report

Answer 14

Complete any time damage has been done to private or city property, captain notifies BC, NC notifies DC ops, DC support services, and Risk, form found on workvivo, complete within same shift

Question 15

Report of Employee Injury

Answer 15

Completed anytime an employee is injured regardless of disposition, found on work vivo, employee completes employee section, captain completes supervisor section, filed in admin and Risk indefinitely

Question 16

What forms do we fill out for an employee injury?

Answer 16

Report of Employee Injury - every time

Workers Compensation Claim Form (DWC1) - if employee receives medical attention

EMS report - if employee is transported via ambulance

CAL Osha - if serious, within 24 hours

Employee must obtain a return to work slip or appropriate documentation placing them off duty, forward to BC

Question 17

DWC 1

Answer 17

Workers comp claim form, completed if employee received medical attention, puncture or fluid exposure. Not required for airborne until exposure status is determined
Notify company officer, BC, DC ops, Risk, found on work vivo, complete within same date of injury, submit via email

Question 18

City Vehicle Accident Report

Answer 18

Anytime you are involved in an accident, completed by operator, do property damage report if prop. damage occurred, include city vehicle number in report, do not use form if it was a vehicle vs vehicle (do vehicle accident report)
Notify Supervisor, BC, amb if necessary, OPD for photos, DC ops and RISK
Form found on work vivo, complete at scene, write a memo and retain for future reference (all parties)
Follow up repair request

Question 19

Department Lost/Stolen/Damaged Report

Answer 19

Anytime an item is lost, stolen, or damaged specific to FD
Notify BC and DC ops
Found on workvivo, complete on same shift as incident

Question 20

Do you need PPE authorization form for gloves or hoods?

Answer 20

No

Question 21

Repair Request Form

Answer 21

Any time unit needs repair, notify BC if apparatus OOS, submit electronically

Question 22

Small Engine Fuel Request

Answer 22

Order when last container is below 1/2, found on work vivo

Question 23

Employee Transfer

Answer 23

S Drive, Fire, Forms, OFD Transfer request, forward to Goyette via email

Question 24

Explorer Ride Along Evaluation

Answer 24

Completed at end of explorer ride along

Question 25

Ride Along Waiver

Answer 25

For all non city employees, under 18 guardian has to sign, ride along from 0900-2200, email to training captain, filed for 5 years

Question 26

Staff Study Report

Answer 26

To include: Summary, recommendations, findings, conclusion, comments
Used to present info
Share drive, fire, forms, admin, staff study report, written as a memo

Question 27

T Form

Answer 27

Supervisor may documents achievement and development, assists with writing evaluation
S drive, fire, forms, admin, t-form
Supervisor saves on H drive

Question 28

Request for Approval of Training Center Use

Answer 28

Email to training bureau, form on S drive , fire, forms, training, TC use agreement, attach this to email with supporting justification, finance approval for >$5000, CM/CC/BB&K if money exchange is >$5000

Question 29

Request for Approval of Training Course Attendance

Answer 29

Submit flyer and documents, training processes request, found on work vivo

Question 30

Training Roster

Answer 30

Paper is used to track personnel, it then must be entered in target solutions

Question 31

Citizen Incident Form

Answer 31

HR form, work vivo, completed anytime there is an unusual incident involving citizen which is not a citizen complaint

Question 32

Employee Consultation Report

Answer 32

HR form, work vivo, documentation of counseling session

Question 33

Do you do a property damage form for a vehicle vs vehicle accident?

Answer 33

No, vehicle accident report only

Question 34

Do you do a property damage form for a vehicle vs structure accident?

Answer 34

Yes

Question 35

Forms required following vehicle accident

Answer 35

Vehicle accident report
Property damage (STRUCTURE INVOLVED)
Facility maintenance (STATION INVOLVED)
Apparatus repair request
EMS report for injuries
All personnel memos
Report of Employee Consultation (*REPEAT OFFENDER)

Question 36

What do you do with vehicle accident forms if accident occurred on a call?

Answer 36

Attach to Image Trend report

Question 37

What is a report of employee consultation?

Answer 37

A written receipt of a conversation between an employee and supervisor. It makes the employee aware of a behavior or action that cannot happen again.

Question 38

Employee Assistance Plan information

Answer 38

Workvivo, Employee Wellness
Cigna
Employee + Family, 10 counseling sessions per incident per year, confidential
Phone: 877-622-4327
Online: Workvivo, EAP link on employee wellness