V8 & 9-C1

Question 1

Form 59 multicasualty ICS

Answer 1

Multi casualty incident command form indicating different positions within the ICS command system on an MCI as well as the resource response guides

Question 2

Where do the copies of the form 228 petty cash voucher

Answer 2

Claimant retains the goldenrod

the other two go to MMD at LAO

Question 3

When is the form 260 EMS supply inventory used

Answer 3

Used by BCs during quarterly records inspection to ensure the required inventory of each unit is complete

Question 4

After completion where does the form 260 EMS supply inventory get sent

Answer 4

Forward one copy monthly to the 
paramedic coordinators office 
medic III
training and 
EMS division 
maintain one copy in the stations completed forms file

Question 5

What is the purpose of the form 271 controlled drug reporting form

Answer 5

Provide tracking mechanism anytime controlled drugs
morphine sulfate or
Medazolam (versed)
are broken expired lost or stolen

Question 6

What should site supervisors do if controlled drugs are missing or stolen

Answer 6

Immediately notify the jurisdictional BC and the narcotics PM coordinators office

Question 7

How should broken vials seals or expired narcotics be replaced

Answer 7

Through the battalions division supply coordinator using form 271 within five business days

Question 8

What do you do with completed form 271s

Answer 8

A copy is maintained at the administrative side for three years and
the original is forwarded to the narcotics PM coordinators office

Question 9

What is the form 272 prehospital controlled drug sign out sheet

Answer 9

It provides a written record of the disbursement of controlled drugs

Question 10

What do you do with completed form 272s

Answer 10

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

Question 11

When is the form 272 completed and forwarded

Answer 11

Battalion chiefs are responsible to ensure it is completed and forwarded to the paramedic coordinators office by the 10th of each month

Question 12

Form 355 report on outside employment is completed how often

Answer 12

It is completed annually and outside employment is limited to 24 hours per week

Question 13

When are form 355 report on outside employment due

Answer 13

Battalion chief will submit to division chief by March 15

division chief submits to compliance officer by April 1

Question 14

How long do you have to seek medical attention after filling out a form 381 employees report of injury or illness

Answer 14

If medical treatment is declined employee may seek medical treatment during one year following the date of injury or illness

Question 15

If a form 381 employees report of injury or illness is filled out what must the supervisor do

Answer 15

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

Question 16

What are the requirements of form 384 limited duty assignment agreement

Answer 16

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

Question 17

When is a form 662 incident activity record completed

Answer 17

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.

Question 18

How many employees or how many incidents can be reported on each form 662

Answer 18

Only one employee on one incident perform 662

Question 19

What shall be included with each completed and approved form 662

Answer 19

A photocopy of the supervisor approve time card or IPFIRS screen 17 for each reported employee

Question 20

Where are forms 662 packages sent to and how soon must they be sent

Answer 20

Must be submitted to FMD cost recovery unit
as soon as possible
prior to 14 calendar days from the end of the incident assignment

Question 21

How long must a form 662 to be kept at the worksite

Answer 21

A copy of the completed form 662 shall be maintained for one year

Question 22

When is a form 703 notice of through channels internal correspondence used

Answer 22

Form 703 is used when correspondence as directed to a level above the employees immediate supervisor