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Forms

ADMINISTRATION

Appraisal Form

Appraisal FormAppraisal FormBeneficiary FormCompensatory Time Sheet rev 6-2021Computer List Sign OutCPR Course Pre-RegistrationComputer Problem FormCPR Course EvaluationCPR Course EvaluationCredit Card Expense Reimbursement FormDivision Chief Extra Hours SheetEmergency Contact InformationEmployee Interview FormEmployee Orientation SkillsEmployee Right To Know ActFax SheetFloating Holiday Pay-OutFirefighter Bill of RightsFixed Asset Record - FillableGrievance Form 19-22 ContractHold Harmless Agreement - LaFrance AntiqueHold Harmless Agreement - District Activities and ApparatusInsurance 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 CardRequest 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 PrintUniforms - Signal-15Waiver Employee PhotosVacation Buy-Back Request Form Admin PersonnelVacation Leave (Bids) rev. 8-2021

 

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 MaintenanceVehicle Accident Procedures 6.21

 

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 DForm EForm FEast Lake Tarpon Special Fire Control District Injury ReportAccient/Damage Report FillablePost Exposure Protocol