Volume 5 - Form Instructions Flashcards
F-351 Time Record
Period Retained : Until the end of Calendar year in Book 55. Retain copies for ____ years.
3 years
F-351
Each member’s F-351 and F-351A shall be stapled together for forwarding to Battalion Headquarters at end of year.
Forward form to Accounting Services Section within ____ days after the end of the calendar year or upon separation from the Dept.
10 days
F-351
FPB or Special Duty members may accumulate a maximum of _____ Regular Day Off (RDO) hours.
80hrs
F-351
Are Jury duty hours (JD) counted towards FLSA hours?
No.
F-351
Court Appearance:
1. If the employee reports to court or is called into court while on call, the employee shall receive a MINIMUM of ____ hours compensation at 1-1/2 times the regular rate of compensation and time and 1/2 pay thereafter. Hrs in attendance is FLSA
- If an employee remains on call and is not required to report to court, the employee shall receive _____ hours of compensation at 1-1/2 times the regular rate of compensation. (On call hrs 0800-1600)
- 2 hours
- 3 hours
F-351
Board of Rights or representing City/Dept at other hearings:
If outside of regular work schedule, member shall receive a minimum of ____ hours compensation at 1-1/2 times the regular rate of compensation and straight time compensation for each additional hour of actual attendance before the Board.
The FSLA Hours Worked entries shall reflect the actual hours the member appeared before the Board
3 hours
F-351
Show-Up Pay:
Whenever a member is required to report to duty either from home or another work location for overtime duty that has been cancelled, he/she shall receive a minimum payment of ____ hours of straight time compensation unless previously notified of the cancellation.
Show-up pay shall not be counted as hours worked
4hrs
F-351
FLSA reporting periods for platoon-duty personnel are ____-day cycles.
27 day
F-351
FLSA hours required to start receiving additional 1/2 pay compensation.
Platoon-Duty: ____ hrs
204hrs
F-2 Journal
What entries shall be made in red ink?
-Date
-Move up, as a result of an alarm
-Alarm Info (emergency & nonemergency)
F-2 Journal
What entries shall be made in green ink?
Payroll Symbols for assigned members
(For members not assigned, payroll symbols shall be in blue or black ink.)
F-2 Journal
General daily activity entries shall be what color ink?
Blue or black
F-2 Journal
Move-up companies shall enter in the journal of the station whose quarters they occupy, the following information:
- Arrival time and assignment designation.
- Time, location, and any pertinent information of alarms.
F-5054A FLSA
2 copies required. How long is the duplicate copy kept at the station combined file?
3 years
F-5054 FLSA
What is this form used for?
-To report FLSA overtime worked in FLSA work period.
-To report FLSA worked when a member is transferred from special-duty to platoon duty or vice versa.
F-5054A Code Definitions:
F-5054A
- Platoon-duty supervisors shall forward the F-5054A within _____ calendar days following the FLSA ending date.
- Special-duty supervisors shall forward the F-5054A _______ following the FLSA ending date.
- F-5054A’s forwarded due to transfer from one FLSA period to another (ex: special duty to platoon) shall be forwarded within _____ calendar days after the effective transfer date.
- 3 calendar days
- the next regular working day
- 4 calendar days
F-5054 Weekly Overtime Report and F-5054 Exception Time Report -Uniformed Personnel
The duplicate copies are kept at point of origin for _____ years, then discarded.
2 years
F-5054 Weekly Overtime Report and F-5054 Exception Time Report -Uniformed Personnel
The original copies shall be forwarded through channels to Headquarters every _______.
Sunday
F-5054 Weekly Crew Time Sheet - Overtime Report Uniformed Personnel
Will Administrative Overtime be reported on this form?
No. DO NOT use this form to report Admin Overtime
F-5054 Weekly Crew Time Sheet - Overtime Report Uniformed Personnel
When a member is notified of a SOD assignment at a location other than their normal work assignment, and when notification is of such short duration that they are unable to report to that assignment without first reporting to their normal work assignment to pick up their personal clothing and equipment, when shall that member be considered on duty?
at the time they report to their normal work assignment to pick up their clothing and equipment.
F-5054 Weekly Crew Time Sheet - Overtime Report Uniformed Personnel
Actual overtime worked for when a member reports for duty midday from home (not scheduled SOD) shall be rounded off to the last full ______ of an hour.
1/10th of an hour (6 minutes)
F-5054 Weekly Crew Time Sheet - Overtime Report Uniformed Personnel
Normally, Emergency Overtime Duty (EOD) required approval by submitting an F-23 thru channels.
What circumstances require no prior approval for EOD?
1) Recall for major emergencies.
2) Late relief.
3) Overtime for other purposes, the need for which could not be anticipated or scheduled in advance, and which is essential in meeting the Department’s responsibilities.
F-5054 Weekly Crew Time Sheet - Overtime Report Uniformed Personnel
Emergency Overtime (EOD) is paid at 1-1/2 time for the following activities/work obligations:
-Court time (deposition)
-Court on call
-Dept. Staff/Emer. Call
-Fire Safety Watch for filming or other
-Emergency Inspections (FPB)
-Arson Staff/Emer. Call
-Late Relief
-Board of Rights, State or Local Admin Board.
-Major Emergency Recall
F-5054 Weekly Overtime Report and F-5054 Exception Time Report -Uniformed Personnel
Original forms will be routed to _________.
Accounting Services Section
What F-5054 form is used to record Light Duty hours worked?
F-5054 Weekly Exception Time Report
F-5054 Weekly Exception Time Report
Symbols used on Exception sheet:
F-5054 Weekly Exception Time Report
Make no entries on this form for any of the following:
-F-360 Trades (unless member uses time off on payback)
-Holidays (Working or Taking Off)
-Administrative Time Off
-Administrative Details
F-5054 Weekly Exception Time Report
When a member goes off duty “Bereavement Leave,” “Preventive Medical Leave,” “Family Illness,” or “N.I.O.D. Sick Leave,” while on duty on a regularly assigned day, entry will show _______ (whole, half, 1/10th?) hours off duty
Whole hours
I.E. Member off for any of the above at 1140 hours. Rounds off to nearest whole hour - 1200 hours.
F-5054 Weekly Exception Time Report
The use of banked SOD hours to balance undertime must be indicated as “_____” on F-5054, Exception Sheet.
TS
State in F-5054 Remarks Column, “Using SOD time to balance undertime.”
F-351 Time Record
When two members arrange for an “Adjustment of Platoon Schedule” (Trades), enter the plus (+) and minus (-) hours in pencil in this column next to the appropriate pay periods. As each half of the trade is consummated and at the close of the pay period, _____ the entry.
Ink the entry
F-3 Hazardous Substance Exposure Report
-Permanently retained by MLU
-Forward immediately following exposure
Routing (2 copies):
-Original to ________
-Duplicate to ________
-Original to MLU
-Duplicate retained by employee
F-8 Roster Change
This form shall be completed and forwarded within 24 hours whenever a member changes any of the following:
A. Place of residence
B. Telephone number
C. Marital status or domestic partner status
D. Legal name - Last Name (ALL CAPTITALS), First Name and Initial (if any)
Changes made on the form which differ from the records on file shall be in underlined in ______ ink.
Red
F-8 Roster Change
If a member is unable to forward an F-8 within 24 hours following a change, verbal notification shall be made to the on-duty station commander within that time.
When shall an F-8 be forwarded?
during the next scheduled working shift.
F-8 Roster Change
Number of Copies for Uniformed personnel: 2
Routing:
Through channels to _______
Personnel Services
F-23 Emergency Overtime Report
Used:
(1) to apply for approval of actual time and one half overtime hours worked
(2) To document all time and one-half overtime worked.
Forward F-23 to Accounting Services Section no later than?
No later than the end of the week in which overtime was worked.
F-23 Emergency Overtime Report
Use Payroll code “PA” for cash payment and code “_____” for time (1.5) banked.
OT
F-23 Emergency Overtime Report
Cash payment for “Emergency Overtime” worked shall be allowed only in units of 1/10 hour consisting of a full ____-minute period.
6 minute
The F-_____ Intra-Departmental Memorandum is used by the Fire Prevention Bureau or field officers for written communication between them.
Used to report fire and life hazards, code violations and other information as required.
F-44
F-49 Request for City Ordinance Leave
This form is to be used by Firefighters to request leaves due to?
-Illness in Immediate Family
-Death in Immediate Family
-Preventive Medical Leave
(The hours requested off for the above leaves will be entered to the nearest whole hour.)
F-49 Request for City Ordinance Leave
How long is the form retained?
One year in personnel file at member’s place of assignment.
F-70 Fire Hydrant Test Record
How long retained for?
file in company file for one year
How long is a Stores Requisition F-80 retained?
Three ______ (days/months/years?) after receipt of material or services.
Three ______ (days/months/years?) at the fire station combined file for F-80 Medical Supply orders.
-Material or services: 3 months
-Medical Supplies: 3 years
Fire Hydrant Record F-95
Used by company commanders to keep a record of fire hydrants in their first-in district, and to list them in proper order for _______.
Testing
Fire Hydrant Record F-95
If any change is made in the order of listing, or any other entry is made on the form the company commander shall make verbal notification to the _______ of such change.
Hydrant Office
Fire Hydrant Record F-95
Private hydrants listed shall be identified as _______
“Pvt. Hyd.”
FIRE HYDRANT RECORD F-95
Initiated by?
Period Retained?
-Company Commander
-Permanently retained.
Emergency Activity Record/Personnel F-101
This form in conjunction with the F-101B provides officers with a field journal to document response personnel and apparatus. The record will be used to support required after action reports and claims for State or Federal reimbursement.
This form will serve as a historical record and assist in preparing OES F-____ & ICS _____.
-OES F-42
-ICS 214
Hose Inventory Record F-121
This form shall be used to record the issue date, number of lengths and description of fire hose. Refer to form information when notifying __________ of hose problems or need of hose replacement.
It shall be kept in Book 55.
Equipment Engineering Unit
Hose and Salvage Cover Record F-128
This form shall be used in conjunction with Form F-122 to keep an accurate record of all hose and salvage cover CHANGES. It shall be kept in Book 55.
It shall be retained for?
6 months after date of last entry
Annual Hose Test Record F-129
This form shall be used to record annual hose tests. List each section that failed by SIZE and SECTION NUMBER, type of failure and contributing cause (if known).
When completed forward to __________.
Duplicate kept in Book 55.
Equipment & Engineering Unit (S&M)
Accident Report F-150
Initiated by Investigating Officer
Forward immediately after obtaining all necessary accident related reports (LAPD documents, F-225, Form Gen. 88, F-80, witness cards etc.) or within _____ calendar days with the completed Department packet.
-7 calendar days
(Any extension beyond seven days needs the Bureau Commanders approval and notification to the Bureau of Emergency Services.)
NIOD Injury or Illness F-166B
Supervisors may no longer ask a member to provide a reason for their NIOD illness or the nature of their NIOD injury. All F166-B forms shall list only “______” or “______” as an explanation in the “How did accident or exposure occur” section.
Injury or Illness
NIOD Injury or Illness F-166B
Period retained and where?
1 year in personnel file at members assignment
What form will be used when leaving equipment (salvage covers, sprinkler heads, ect.) at a scene of an incident?
-Equipment Loan Receipt F-215
(2 copies - 1 for station, 1 for RP onscene. Retained until equipment is returned)
What form is to be carried on Rescue Ambulances and will be completed by member leaving equipment at the receiving medical facility? (Backboard, splints, ect.)
Rescue Equipment Loan Receipt F-215M
(Retained 72 hours max or until equipment is returned)
Report of INFORMAL Grievance Discussion F-226-A
As soon as possible and within _____ calendar days of the date the informal discussion is requested by the grievant, the immediate supervisor shall meet with the grievant, investigate the grievance, inform the grievant of his decision, and complete and forward the F-226-A.
This report shall be delivered through channels to ___________.
Filed indefinitely in grievance file.
-15 calendar days
-Department Management Representative
Statement of FORMAL Grievance - F-226-B
This form shall be initiated by the grievant to request review of a grievance at all formal levels of review within the Department’s grievance procedure.
It shall be forwarded within _____ calendar days from date grievant received reply on F-226-A or date F-226-C is delivered.
-15 calendar days
(Delivered to BC for first level of review, then goes to the Dept Management Representative)
What form is to be used by all reviewers to reply to an F-226B Statement of Grievance - Formal?
F-226C Reply to Statement of Grievance
Request for Legal Action F-290
-The F-290 is used to summarize information needed for prosecution of a case if unable to secure compliance of the Fire Code.
-Company/Unit Commander AND Battalion/Section Commander shall review and initial prior to forwarding.
-Retained for 5 years
-Photos shall be taken which clearly show all observable violations. Photos shall include:
-Front of the building
-Close-up of address
-Close-up of each observable violation
What form is issued for open outdoor fires where there is no intention to dispose of “waste” and “refuse” material or in cases where no other form is suitable to fulfill the needs of a particular instance?
Special Permit F-315
(The Battalion Commander or the member directed to do so may issue the Special Permit, but only after an on-site inspection and careful consideration of the conditions present at the location.)
Special Permit F-315
Permits for open cooking fires may be issued by:
-FPB personnel
-Company or higher Commanders
Special Permit F-315
Whenever issuing an F-315 permit for any barbecuing device, attach the Form F-_____.
F-863 Barbecue Permit Instructions
What form is used to record citizen’s complaints and requests for assistance with fire prevention problems?
F-334 Complaint of Hazard
Fire/Life Safety Violation F-340 A, B, C, E
These forms are to be used by all members to request correction of fire and life hazards and code violations.
Forms shall be retained for?
3 years
What form is used to require testing, maintenance, and repair of fire protection equipment as per Chief’s Regulation Number Four and L.A.M.C. 57.01.35?
The form provides certification that testing, maintenance and repairs have been completed.
Fire Protection Equipment Performance Certification F-340D
Fire Protection Equipment Performance Certification F-340D
Period Retained?
5 years or until next certification
Fire Protection Equipment Performance Certification F-340D
-This form requires testing to be performed within ____ days of the issuing date.
-Correction of defects shall be completed within ____ days of the initial test date.
30 days for both
F-340FW Fire/Life Safety Violation Fire Watch
A patrol log shall be maintained.
The responsible person shall patrol their designated area how often?
Each half hour
Adjustment of Platoon Duty F-360 (Trades) and Request for Time off/Vacation F-361
Who approves Station Commanders and EMS District Captains F-360 and F-361?
Immediate supervisor
Request for Time Off/Vacation Time F-361
Members requesting TS time off on the working half of a trade shall state, “_______” in the comment section of the F-361, and underline the statement in ______ ink.
-“TS on trade day” in comment section
-red ink
Request for Time Off/Vacation Time F-361
AOD and TS requests retain until?
Vacation/Holiday requests retain until?
AOD/TS: end of pay period concerned
VC/Holiday: end of calendar year
Request for Time Off/Vacation Time F-361
Members who are scheduling a floating holiday shall secure a guarantor when scheduling the holiday within ____ days or less.
5 days
What form is used to notify companies of private hydrant installation and the type of water system to which the hydrant is connected?
F-366 Report of Private Hydrant
(Initiated by Hydrant Office)
Bi-Monthly Preventive Maintenance Record F-377
Period Retained?
Last 6 copies in LOG BOOK at all times (1 year)
Bi-Monthly Preventive Maintenance Record F-377
- Forward copy to Battalion Commander within ________.
- Copy to arrive in the Battalion office no later than?
- First 2 weeks of the month.
- Day before Battalion inspection or the 15th of the appropriate month whichever comes first.
(The Battalion Chief shall return the initialed form the day of inspection and replace the duplicate copy in the apparatus’s Log Book.)
Bi-Monthly Preventive Maintenance Record F-377
________ shall initial the F-377 after the needed repairs have been called in or prior to forwarding to the Battalion Commander if no repairs are needed.
-Station/Unit Commanders
(In addition, a requisition listing all needed repairs shall be forwarded with the original copy of the F-377 to the Battalion Commander.)
Apparatus Yearly Mileage F-380
Station Commanders shall locate and record the FISCAL year (July) mileage for all apparatus assigned to their command.
Forward by the _____ day after the end of the FISCAL year (July).
10th day
Apparatus Yearly Mileage F-380
When apparatus is transferred, a copy of the last F-380 must be forwarded with the log book.
If vehicle was not issued a log book, a copy of the F-380 will be secured in the ______.
glove box
What form is to be used to make changes on Weekly Crew Time Sheets Form #5054 (Positive Timekeeping),Form #5054 (Firefighter Exception), and Form #5054 (Firefighter Overtime)?
F-398 Weekly Crew Time Sheet CORRECTION Needed
(Kept at Accounting Services until usefulness has passed)
F-590 Record of Overtime
Long term vacancies shall be a vacancy (not including vacation) of over ____ days.
27 days
(3 segments before hiring rotates around battalion, then each station has it for 1 segment)
(REMEMBER a normal platoon duty working period is NINE 24 hour shifts in a 27 day period)
F-590 Record of Overtime
All work numbers (for SOD) will be recorded as:
-10 to 19 hours = 1 number
-20 to 24 hours = 2 numbers
No number is recorded for less than ____ hours of work.
10 hours
(The system operates on a four-month cycle.)
F-590 Record of Overtime
No member shall be permitted to work additional SOD hours if such SOD hours would cause the member to work in excess of _____ CONSECUTIVE HOURS without first rotating the SOD opportunity throughout the Battalion concerned.
120 hours
F-590 Record of Overtime
A member shall not be hired to work additional SOD hours if the member has worked or is scheduled to work _____ hours of SOD or more in a calendar month without rotating the SOD opportunity throughout the entire Battalion concerned and securing permission from the Battalion Commander.
144 hours
F-590 Record of Overtime
Members hired to work “V” hours for less than _____ hours may cancel up to the point of actually starting the work assignment, but members cannot cancel a SOD day to take an available SOD day that has more or less hours if it is 5 days or less to the scheduled SOD day.
10 hours
F-590 Record of Overtime
When a notice to cancel a scheduled SOD day is _____ days or less, no member will be permitted to cancel unless another member accepts the role of guarantor.
5 days
F-590 Record of Overtime
No special duty member shall be allowed to work more than _____ hours of SOD in a calendar month unless the SOD day has first been rotated throughout the Battalion where the SOD day exists.
96 hours
F-590 Record of Overtime
Special Duty hiring priority is rotated within the rest of the battalion stations how often?
Every 4 months
(Side note - Special duty members shall not be allowed to trade SOD days.)
F-702 Assignment Record (Apparatus)
When are entries made?
Whenever apparatus is DETAILED or TRANSFERRED
F-731 Apparatus Operator Qualification (Cert page in PRB)
The purpose of this entry is to confirm the adequacy of training and performance of the member as outlined in 7/1-01.01.
-If a member is restricted from driving department apparatus, it shall be in RED INK
-Entries made in pencil
-Entries made by officer RESPONSIBLE for APPARATUS
-officers must certify members regardless of previous certifications on same apparatus
-approved by BC
F-734 Illness or Injury — Continue Duty
This page in the PRB provides a record of a member’s on duty illness or injury for which no medical examination was given.
All entries on the F-734 shall be recorded in the _______.
F-2 Station Journal.
F-745 Hazardous Substance/Communicable Disease Exposure Record (Page in PRB):
-Along with documentation of exposures to hazardous substances and communicable diseases, the F-745 will be used as a source of information when a member files a Worker’s Compensation claim for any duty related illness
F-903 Controlled Medication Inventory Record
This form shall be maintained by each resource approved to carry and maintain a supply of Controlled Medications:
-Initiated by: Both medics riding RA
-Period Retained: 3 years
-Completed at the start of each shift, anytime personnel change, and when inventory changes
F-904 Situation Report
Used to intake inquiries and provide timely feedback to members regarding matters relative to Departmental:
-policies and procedures
-practices
-system performance
-fire and life safety
-patient care issues.
Routing:
-Original THROUGH CHANNELS to EMS Captain
-Duplicate to Quality Improvement Section
F-957 Company Activity Schedule
-Station Commander shall use this form to list all planned station activities for each shift in the ensuing month.
-Routing: To BC Office AT LEAST ____ days PRIOR to start of month
5 days
F-973 Apparatus and Equipment Check (weekly&monthly checks)
Officers shall be responsible for the use of these forms to keep an accurate record of required apparatus and equipment checks.
The form shall be kept in ______.
-Book 55
(If the check is O.K., the INITIALS of the member will be entered in the appropriate column. If the check is not O.K., a journal entry shall be made and the page number entered in the column instead.)
F-1000 Injury Status Form
This form is used to provide the first care doctor or Worker’s Compensation doctor with a checklist of duty status recommendations.
It also allows notification to MLU of any changes in member’s duty status and provides proper billing info.
-After seeing workers’ comp doctor, member SHALL report to MLU within 1 business day.
-After each appointment, fax/email F-1000 to MLU.
F-1001 NIOD / Family Illness Status Form
This form is used to establish proof of illness or disability, including work restriction from private medical doctor for NIOD illness or injuries:
-Members who are required to provide justification for NIOD leave shall go to a physician THAT DAY and secure a MEDICAL TREATMENT CERTIFICATE or F-1001 signed by the physician.
-Upon return to duty, the completed medical treatment certificate or F-1001 shall be presented to the member’s immediate supervisor. Supervisors shall forward the documentation to MLU.
F-1104 Notice to Improve Performance
When a deficiency has been observed in a member’s APPEARANCE, ATTITUDE, WORK HABITS, PERFORMANCE or ACTIONS, ANY supervisor with direct knowledge of the deficiency may use a Notice to Improve Performance (NTI) as a tool to secure correction.
How long does a member receiving a F-1104 have to correct the issue?
-Not longer than 6 months
(If the deficiency is not corrected, subsequent notices to improve may be issued and possibly lead to disciplinary action)
F-1105 Reprimand
The Reprimand is to be used in case of serious or repeated violations that necessitate appropriate action and proper documentation.
After a complete investigation into the violation, all Reprimands shall be written by _______.
-PSD
(Once Reprimand is forwarded to the member’s immediate supervisor, the supervisor shall print and sign 3 originals of the Reprimand and issue them to the member for signing. Forward signed documents to PSD)
F-1109A Waiver of Claims for Damages
F-1109B Indemnity Agreement
Both forms: To be prepared by responsible Officer before visitor uses Fire Department facilities or equipment under such circumstances that personal injury may occur.
The F-1109B Indemnity Agreement is to be completed whenever a Department facility, apparatus, or equipment is used to demonstrate equipment by an independent vendor or persons.
F-1122 Performance Evaluation
Members shall indicate whether they concur or do not concur with the evaluation and sign the form. If a member does not concur, the member has an agreed upon time (ASAP) or a maximum of ____ calendar days to make a statement on the back of the form or on attached pages, giving reasons for not concurring.
30 CALENDAR days
F-1122 Performance Evaluation
-Members assigned to task force stations shall be rated by the Task Force Commander with the assistance of subordinate officers both in the rating and interview.
-If the Station Commander is Paramedic-certified, the Station Commander will complete Part III; if not, Part III will be the EMS Capt assigned to the District.
F-1122 Performance Evaluation
If at any time a Firefighter/ Paramedic receives an “overall” evaluation rating that is UNSATISFACTORY, a F-225 shall be forwarded, through channels, to the _________.
Bureau Commander
F-1122 Performance Evaluation
What circumstances warrent conducting a F-1122?
-Probationary Period Eval (promotion)
-Annual Eval
-6th Step
-Longevity
-Transfer
F-1132 Officer Performance Evaluation
Rater will normally be the immediate supervisor of the member rated. The Battalion Commander shall rate the Station Commanders and the Station Commander shall rate the other Captains within the Station.
F-23 Emergency Overtime Report
How long retained and where?
2 years in station/unit file
Cal/OSHA 200
Used for all employees as an annual log and summary of Cal/OSHA recordable occupational injuries and illnesses.
It shall be posted on the Official Business bulletin board no later than _______ and shall remain in place until March 1.
February 1
(Initiated by Station Commander and shall be completed during the January following the calendar year to which it relates and it is imperative that it be accurate.)
