V8 & 9-C1 Flashcards
Form 59 multicasualty ICS
Multi casualty incident command form indicating different positions within the ICS command system on an MCI as well as the resource response guides
Where do the copies of the form 228 petty cash voucher
Claimant retains the goldenrod
the other two go to MMD at LAO
When is the form 260 EMS supply inventory used
Used by BCs during quarterly records inspection to ensure the required inventory of each unit is complete
After completion where does the form 260 EMS supply inventory get sent
Forward one copy monthly to the paramedic coordinators office medic III training and EMS division maintain one copy in the stations completed forms file
What is the purpose of the form 271 controlled drug reporting form
Provide tracking mechanism anytime controlled drugs
morphine sulfate or
Medazolam (versed)
are broken expired lost or stolen
What should site supervisors do if controlled drugs are missing or stolen
Immediately notify the jurisdictional BC and the narcotics PM coordinators office
How should broken vials seals or expired narcotics be replaced
Through the battalions division supply coordinator using form 271 within five business days
What do you do with completed form 271s
A copy is maintained at the administrative side for three years and
the original is forwarded to the narcotics PM coordinators office
What is the form 272 prehospital controlled drug sign out sheet
It provides a written record of the disbursement of controlled drugs
What do you do with completed form 272s
Completed prehospital controlled drug sign out sheet should be kept for three years by the paramedic coordinators office and a copy retained at the administrative side for one year
When is the form 272 completed and forwarded
Battalion chiefs are responsible to ensure it is completed and forwarded to the paramedic coordinators office by the 10th of each month
Form 355 report on outside employment is completed how often
It is completed annually and outside employment is limited to 24 hours per week
When are form 355 report on outside employment due
Battalion chief will submit to division chief by March 15
division chief submits to compliance officer by April 1
How long do you have to seek medical attention after filling out a form 381 employees report of injury or illness
If medical treatment is declined employee may seek medical treatment during one year following the date of injury or illness
If a form 381 employees report of injury or illness is filled out what must the supervisor do
Entry in the business journal
file a copy in the employees work site personnel file
deliver a copy to return to work section within 24 hours
What are the requirements of form 384 limited duty assignment agreement
Ensures employee bureau and supervisor are aware of work restrictions and assignment time frames they are temporary and should last no more than 90 calendar days
When is a form 662 incident activity record completed
Whenever personnel are assigned to a working second alarm or greater brushfire for more than 30 minutes
or when requested after assigned to a qualifying incident such as earthquake rainstorm civil unrest etc.
How many employees or how many incidents can be reported on each form 662
Only one employee on one incident perform 662
What shall be included with each completed and approved form 662
A photocopy of the supervisor approve time card or IPFIRS screen 17 for each reported employee
Where are forms 662 packages sent to and how soon must they be sent
Must be submitted to FMD cost recovery unit
as soon as possible
prior to 14 calendar days from the end of the incident assignment
How long must a form 662 to be kept at the worksite
A copy of the completed form 662 shall be maintained for one year
When is a form 703 notice of through channels internal correspondence used
Form 703 is used when correspondence as directed to a level above the employees immediate supervisor
