FORMS Flashcards
Memorandum
Addresses city employees, notifies them of internal changes, specific problems/solutions, or events. Memo template found on workvivo, if numbered memo…filed indefinitely
Community Engagement Request
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
PACE
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
Reimbursement Request
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
What form do we fill out following a community event?
Community Engagement Survey, done by Captain
Which sections of exposure documentation report do we do?
A and B
Who is contacted regarding exposures?
BC and DICO
Narcotic Discrepancy Memo
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
Adult Abuse
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
Child Abuse
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
Sharps Log Injury
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)
Submersion Incident Report
Any water related incident involving children (even no transport), notify EMS bureau, seamless doc on iPad, forwarded to Safe Kids Inland Empire
CAL OSHA
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
Property Damage Report
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
Report of Employee Injury
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
What forms do we fill out for an employee injury?
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
DWC 1
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
City Vehicle Accident Report
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
Department Lost/Stolen/Damaged Report
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
Do you need PPE authorization form for gloves or hoods?
No
Repair Request Form
Any time unit needs repair, notify BC if apparatus OOS, submit electronically
Small Engine Fuel Request
Order when last container is below 1/2, found on work vivo
Employee Transfer
S Drive, Fire, Forms, OFD Transfer request, forward to Goyette via email
Explorer Ride Along Evaluation
Completed at end of explorer ride along
