Forms

Front 1

Employee Evaluation Report FD 17

Back 1

1. All probe's require a FD 17 filled out on the last shift of each month.

2. Each rating requires a comment.

3. Unacceptable, short of standard, standard, above standard, outstanding.

Front 2

Employee is injured. What form required.

Back 2

FC-6 Supervisors report of injury

FC-11 Medical Service order Occupational health providers list.

FC-17 Employee's clam for worker's compensation benefits (DWC-1)

Front 3

Loss of property or equipment. What form?

Back 3

FC-18. Fill out within 48 hours of loss.

Include written memorandum to deputy chief through BC.

Police report may be required.

Front 4

Pre-Trip inspection report. Form #?

Back 4

FD-3

If apparatus is unsafe to operate, notify BC and shop.

Front 5

Priority Target Hazard form #?

Back 5

FD-7. Route through BC

Front 6

Public Education Form

Back 6

FD 18. Fill one out for any pub ed event. Route to ops secretary on completion of event.

Front 7

Tardy Report

Back 7

FD 21. Filled out as soon as sufficient information is available to complete the report. Route through superior officers to the personnel manager at HQ.

Front 8

Hydrant repair requisition.

Back 8

FD 25. For broken hydrants. Route to station 17 captain, then to department of public utilities water division.

Front 9

Apparatus Inventory

Back 9

FD 27 and 27A.

Fill out annually on the last day of August.

Route through BC to Ops chief.

Front 10

Station Inventory

Back 10

FD 28 and 28.1

Fill out annually on last day of August.

Front 11

Hose and Salvage cover inventory

Back 11

FD 29

Fill out last day of May annually.

Route through BC to Ops chief.

Front 12

Possible substance use incident form

Back 12

FD 31

For supervisors who observe reasonable cause for drug/alcohol testing.

Two supervisors must document specific observations that constitute reasonable cause for drug/alcohol testing. Once completed, a copy of this form is provided to the member.

Front 13

Temporary Equipment transfer checklist

Back 13

FD 34

Use when temporarily transferring equipment from on apparatus to another.

Front 14

Projected work details

Back 14

FD 40

Shift by shift projection of monthly work details and work actually accomplished.

Route to BC.

Complete duplicate form and maintain at station.

Complete work actually completed section and route to BC.

Front 15

Annual station safety and maintenance inspection form.

Back 15

FD 53

Used annually for the purpose of inspecting fire stations to help maintain a safe work environment.

Complete in August prior to the annual station inspection performed by BC.

Front 16

Fuel report form

Back 16

FD 61

Report of fuel purchased when using outside vendor for refueling. Sign receipt and attach to form. Record in day book.

Route to finance section.

Front 17

Incident tracking log

Back 17

FD 64

Form will assist IC in the tracking of members and equipment moving between functional locations during large emergency incidents.

Front 18

RIC checklist form

Back 18

FD 66

Checklist used to size up and evaluate minimum equipment needed.

Front 19

Apparatus, equipment and office inspection form.

Back 19

FD 70A

Checklist of items in need of inspection.

Done annually during May.

Through BC to Ops Chief.

Front 20

Personnel inspection form

Back 20

FD 70B

Check list of items in need of inspection for personnel.

Annually during January

Route through BC to Ops chief.

Front 21

Station Inspection form

Back 21

FD 70C

Checklist of items for station inspection

Annually in september.

Front 22

Station work schedule form

Back 22

FD 81

Daily, weekly and monthly checklist of station duties.