Volume 5 - Form Name Memorization Only Flashcards
1
Q
What Form Name?
F-8
A
Roster Change (form on NSS)
2
Q
What Form Name?
F-17
A
Pay Grade Advancement Special/Hazard Pay Application
3
Q
What Form Name?
PGA-1
A
Pay Grade Advancement Application
4
Q
What Form Name?
F-18A
A
Request for Transfer Uniformed Members (Form on NSS)
5
Q
What Form Name?
F-18B
A
Request for Transfer Primary Vacancies (Form on NSS)
6
Q
What Form Name?
F-23
A
LAFD Emergency Overtime Report (Form on NSS)
7
Q
What Form Name?
F-70
A
Fire Hydrant Test Record
8
Q
What Form Name?
FG-79
A
Notice of Commendation (Form on NSS)
9
Q
What Form Name?
FG-84B
A
Witness Card
10
Q
What Form Name?
F-86
A
Humanitarian Member Visitation
11
Q
What Form Name?
FG-88
A
Automobile Accident Report
12
Q
What Form Name?
F-95
A
Fire Hydrant Record
13
Q
What Form Name?
F-100
A
What is Your Suggestion?
14
Q
What Form Name?
F-101
A
Emergency Activity Record/Personnel
15
Q
What Form Name?
F-101MULTI
A
Emergency Activity Record/Operations
16
Q
What Form Name?
F-121
A
Hose Inventory Record
17
Q
What Form Name?
F-128
A
Hose and Salvage Cover Record
18
Q
What Form Name?
F-129
A
Annual Hose Test Record
19
Q
What Form Name?
F-150
A
Accident Report
20
Q
What Form Name?
F-215
A
Equipment Loan Receipt
21
Q
What Form Name?
F-226A
A
Report of Informal Grievance Discussion
22
Q
What Form Name?
F-226B
A
Formal Statement of Grievance
23
Q
What Form Name?
F-226C
A
Grievance Reply
24
Q
What Form Name?
F-392
A
Monthly Gasoline and Diesel Fuel Report
25
What Form Name?
F-666
Resource and Situation Status Record
(This is a two-sided form. One side is for multi-story incidents such as high-rise or ship incidents, the other side is for brush or one-story type incidents.)
26
What Form Name?
F-666W
Wildland Resource and Situation Status Record
27
What Form Name?
F-1106
Change of Status
28
What Form Name?
F-1109A
Waiver of Claims for Damages
29
What Form Name?
F-1109B
Indemnity Agreement
30
What Form Name?
F-1120
Notice of Intention to Apply for Service Pension
31
What Form Name?
F-1150
Outside Employment Activity Report
32
What Form Name?
F-351
Time Record Work Sheet
33
What Form Name?
F-351C
Time Record Worksheet FLSA Record
34
What Form Name?
F-96ML
Military Leave Timeoff/Compensation Form
35
What Form Name?
F-1104
Notice to Improve Performance
36
What Form Name?
F-1105
Reprimand
37
What Form Name?
F-1122
Performance Evaluation - Uniformed Personnel
38
What Form Name?
F-1132
Performance Evaluation - Officer
39
What Form Name?
F-1142
Probationary FF 10-Shift Performance Evaluation Report (Form on ERS Application)
40
What Form Name?
F-1142A
Probationary FF Daily Observation Report (Form on ERG Application)
41
What Form Name?
F-1142C
Probationary FF Performance Log (Form on ERS Application)
42
What Form Name?
F-377
Bi-Monthly Preventive Maintenance Record (Form on NSS)
43
What Form Name?
F-380
Apparatus Yearly Mileage
44
What Form Name?
F-702
Assignment Record
45
What Form Name?
F-704
Apparatus Maintenance Record
46
What Form Name?
F-705
Repair Record
47
What Form Name?
F-709
Inventory of Equipment Firefighting
48
What Form Name?
F-710
Tire Record
49
What Form Name?
F-972
Daily Pre-Trip Inspection Record
50
What Form Name?
F-973M
Monthly Apparatus and Equipment Check Record (Engine and Truck have separate forms)
51
What Form Name?
F-973W
Weekly Apparatus and Equipment Check Record (Engine and Truck have separate form)
52
What Form Name?
F-974
Reserve Apparatus Condition Inventory Record
53
What Form Name?
F-975
Lifeline and Rescue Kit Inspection
54
What Form Name?
F-976
Annual Ground Ladder Inspection Record
55
What Form Name?
F-977
Bi-Monthly Apparatus Inspection Checklist
56
What Form Name?
F-978A
Heavy Apparatus Undercarriage Inspection Checklist
57
What Form Name?
F-978B
Heavy Apparatus Undercarriage Inspection Report
58
What Form Name?
F-979
Self Contained Breathing Apparatus Inspection Checklist
59
What Form Name?
F-63
Fire Prevention Summary (Form on NSS)
60
What Form Name?
F-63A
Record of Fire Prevention Activities (Form on NSS)
61
What Form Name?
F-290
Request for Legal Action
62
What Form Name?
F-315
Special Permit
63
What Form Name?
F-334
Complaint of Hazard
64
What Form Name?
F-340 A,B,C
Fire/Life Safety Violation
(F-340C is blank to fill in items not listed in form A or B)
65
What Form Name?
F-340D
Fire Protection Equipment Performance Certification (Chief’s Reg 4 Test)
66
What Form Name?
F-340E
Fire/Life Safety Violation - Overcrowding
67
What Form Name?
F-340FW
Fire Watch
68
What Form Name?
F-341
Non-Compliance Reinspection Fee Form
69
What Form Name?
F-903
Control Medication Inventory Record
70
What Form Name?
F-1000
Injury Status Form
71
What Form Name?
F-1000 MRSA
MRSA Injury Status Form
72
What Form Name?
F-1001
NIOD/Family Illness Status Form
(Physician’s Work Status/Limitation Notification)
73
What Form Name?
State DWC Form 1
Workers’ Compensation Claim Form
74
What Form Name?
F-1107
Report of Injury Notification to Medical Liaison Unit
75
What Form Name?
F-3
Hazardous Substance Exposure Report (Form on NSS)
76
What Form Name?
F-420
Communicable Disease Exposure and Notification Report (Form on NSS)
77
What Form Name?
F-166B
NIOD Injury or Illness Report for Uniform Personnel (aka Employer’s Report of Occupational Injury or Illness)
(Form on NSS)
78
What Form Name?
Form 5020
Occupational Injury or Illness Report
79
What Form Name?
F-620 Packet
Accident Procedure Packet
80
What Form Name?
F-223
Red Letterhead (No Boxes) - Used for intradepartmental correspondence NOT “Through Channels”
81
What Form Name?
F-225
Red Letterhead, Through Channels (with boxes) - Used for intradepartmental correspondence “Through Channels”
82
What Form Name?
F-228
Black Letterhead - Used for correspondence to governmental agencies, organizations, business, general public etc., and for Letters of Appreciation and/or Invitation within the Dept. Also used for correspondence to elected City officials with the exception of joint communications.
83
What Form Name?
Form Gen. 160
Inter-Departmental Correspondence - used to correspond with all other City departments. May also be used to correspond with City officials IF IT IS a joint COMMUNICATION from Fire Chief and head of one or more departments.
84
What Form Name?
FG-16
Personal Expense Statement
85
Form name and use?
F-666A?
F-666B?
RESOURCE AND SITUATION STATUS RECORD
F-666A is for use at multi-level incidents such as high-rise or ship fires.
The F-666B is for use at single-level incidents such as one-story structures or brush fires.
86
Form Name and use?
F-666C
HAZARDOUS MATERIAL INCIDENT DATA SHEET
(used by the Incident Commander at Hazardous Material Incidents. Each emergency sedan is provided with four copies of the F-666C)
87
Form Name and Use?
F-666E
MULTI-PATIENT INCIDENT WORKSHEET (MCI)
88
Form Name?
F-3000
Supervisor’s Report of Employee’s Physical Characteristics/Behavior
89
Form name?
F-3001
Order for Urine Sample
90
Form Name?
F-3002
Employee’s Voluntary Urine Sample
91
Form Name?
Cal/OSHA 300
Log of Work-Related Injuries and Illnesses
92
Form name?
Cal/OSHA 300A
Annual Summary of Work-Related Injuries and Illnesses
