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FIRE & EMS Documentation Form
This form is to be used to document events that occur within the county to be maintained as a database.
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* Indicates required question
Name
*
Your answer
Email:
*
Your answer
Contact number:
*
Your answer
Name of Department
*
Your answer
Type of Department?
*
FIRE
EMS
DUAL: FIRE & EMS
Other:
Rank:
*
Choose
Chief
Deputy Chief
Battalion Chief
Captain
Lieutenant
Other
Type of event:
*
Choose
Central Communications
New Radio Implementation
CAD
County IT
Utility
BCESTC
Other
All Hazards Plan
Description
*
Your answer
Was the issue reported to the responsible agency/party?
*
Yes
No
Date when reported?
MM
/
DD
/
YYYY
Agency and name of person reported to?
Your answer
Has the issue been resolved?
*
Yes
No
Needs follow-up? (describe below)
Your answer
Level of Seriousness?
*
High
Moderate
Low
Frequency of the Issue?
*
New (1st time occurred)
Continual Issue (has occurred previously in the past)
Describe if you selected 'Continual Issue' in the previous question:
Your answer
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