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Forms

ADMINISTRATION

Appraisal Form

Appraisal FormAppraisal FormAuto Accident ProceduresBeneficiary FormCompensatory Time SheetComputer List Sign OutCPR Course Pre-RegistrationComputer Problem FormCPR Course EvaluationCPR Course EvaluationCredit Card Purchase FormDivision Chief Extra Hours SheetEmergency Contact InformationEmployee Interview FormEmployee Orientation SkillsEmployee Right To Know ActFax SheetFloating Holiday Pay-OutFirefighter Bill of RightsFixed Asset Record - FillableHold Harmless Agreement - LaFrance AntiqueHold Harmless Agreement - District Activities and ApparatusGrievance Form 16-19 Contract.Insurance Information & ReleaseInter-Departmental CommunicationUniforms - Payback FormLocal Traveling ExpensesMileage Allowance Reimbursement Form 5-2019Mutual Aid/Automatic Aid Reimb.Notary AffidavitNotice of Eligibility and Rights & ResponsibilityOvertime Pay RequestPatient Authorization (HIPPA Compliance)Per Diem Reimbursement Meals Lodging Incidentals 5-2019Request for EMS Run ReportRadio & Technology Personnel Maintenance FormReimbursement Form (Only Cash/Non-Department Credit Card)Request for Leave of Absence (Non-Admin) ** This can now be filled out online and emailed to district57@elfr.orgRequest for Leave of Absence (Admin Exempt)Request for Leave of Absence (Admin Non-Exempt) Retention LogSocial Security PermissionSpecial Assignment Pay Time SheetSpecial Pay EMS/CME Instructor Time SheetSpecial Duty Timesheet-WET Supervisor's Check ListThreat Incident ReportSpecial Event Donation FormUniforms- Screen Print Order Form Uniforms - Signal-15Waiver Employee Photos Vacation Buy-Back Request Form for Admin PersonnelVacation Leave (Bid)

 

APPARATUS

DC-57 (543) Daily Vehicle InventoryE56 556 Checksheet.pdfS57 557 Checksheet.pdfE58 558 Checksheet.pdfB58 550 Checksheet.pdfW58 548 Checksheet.pdfProposed Equipment MovementWeekly Vehicle Maintenance

 

EMS 

Ambulance / Hospital Incident ReportBLS Hurricane Shelter Bag E-56Comm Disease Exp. ReportEMS County Supply FormEMS Room Inventory 56/58HANDTEVY BAG Infection Control Exposure ReportMedications Expiring Next MonthMedication Inventory SheetNarcotic Key Activation AccountabilityPhillips MonitorRun Report ReviewStaff Vehicle BLS Trauma Bag InventorySunstar Medication Return FormWaste management Compliance Checklist

OPERATIONS 

Dispatching Errors

STATIONS 

Air Filter Replacement Schedule Station 57Cleaning Supplies InventoryMonthly Maintenance Support Services ChecklistQuarterly Facility Safety InspectionStation Duties Station 57Station Duties Stations 56 & 58Supply Order Form Non-Sani Chem

WORKERS COMP FORMS

Line of Duty Injury ProtocolFlorida FROIForm BForm CForm CForm EForm FEast Lake Tarpon Special Fire Control District Injury ReportAccident/Damage ReportPost Exposure Protocol