FORMS Flashcards

1
Q

Memorandum

A

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

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2
Q

Community Engagement Request

A

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

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3
Q

PACE

A

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

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4
Q

Reimbursement Request

A

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

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5
Q

What form do we fill out following a community event?

A

Community Engagement Survey, done by Captain

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6
Q

Which sections of exposure documentation report do we do?

A

A and B

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7
Q

Who is contacted regarding exposures?

A

BC and DICO

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8
Q

Narcotic Discrepancy Memo

A

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

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9
Q

Adult Abuse

A

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

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10
Q

Child Abuse

A

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

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11
Q

Sharps Log Injury

A

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)

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12
Q

Submersion Incident Report

A

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

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13
Q

CAL OSHA

A

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

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14
Q

Property Damage Report

A

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

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15
Q

Report of Employee Injury

A

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

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16
Q

What forms do we fill out for an employee injury?

A

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

17
Q

DWC 1

A

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

18
Q

City Vehicle Accident Report

A

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

19
Q

Department Lost/Stolen/Damaged Report

A

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

20
Q

Do you need PPE authorization form for gloves or hoods?

A

No

21
Q

Repair Request Form

A

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

22
Q

Small Engine Fuel Request

A

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

23
Q

Employee Transfer

A

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

24
Q

Explorer Ride Along Evaluation

A

Completed at end of explorer ride along

25
Q

Ride Along Waiver

A

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

26
Q

Staff Study Report

A

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

27
Q

T Form

A

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

28
Q

Request for Approval of Training Center Use

A

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

29
Q

Request for Approval of Training Course Attendance

A

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

30
Q

Training Roster

A

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

31
Q

Citizen Incident Form

A

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

32
Q

Employee Consultation Report

A

HR form, work vivo, documentation of counseling session

33
Q

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

A

No, vehicle accident report only

34
Q

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

A

Yes

35
Q

Forms required following vehicle accident

A

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)

36
Q

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

A

Attach to Image Trend report

37
Q

What is a report of employee consultation?

A

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.

38
Q

Employee Assistance Plan information

A

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