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Table of Contents
101.00 Occupational Safety and Health Program
102.00 Fire Department Safety Officer
105.01 HazMat Biological Exposure Form
106.00 Accident & Injury Reporting, Worker’s Compensation
106.01 Fire Service Accident & Injury Report Form
106.02 VFIS-Accident & Sickness Claim
106.03 VFIS-Attending Physician’s Statement
110.00 Driver Operator Requirements for Department Owned Vehicles
110.01 Driver Training Hour Log
111.00 Emergency Response for Department Owned Vehicles
112.00 Riding on Motorized Department Owned Vehicles
113.00 Vehicle Accident Review Board
115.00 Protective Clothing & Equipment
119.00 Rehabilitation at Emergency Scenes and Trainings
119.01 Rehabilitation Vitals Guide
119.02 Individual Rehabilitation Report
120.00 Self Contained Breathing Apparatus (SCBA) Annual Training
120.01 Self Contained Breathing Apparatus (SCBA) Fit Testing
125.00 Medical Evaluation Program – Initial, Biannual, Annual
125.01 Aurora Occupational Health Medical History & Physical Examination Form
125.02 Aurora Occupational Health OSHA Respirator Medical Evaluation Form
201.00 Alcohol and Drug Testing
202.00 Post Accident Alcohol and Drug Testing
203.00 Life Safety Rope (Lifeline)
203.01 Turn Out Gear Specifications
203.02 Helmet Specifications – Helmet Front Uniformity
205.00 Personnaly Owned PPE Authorization Form
207.00 Training & Continuing Education Program
207.01 Training & Continuing Education Request and Reimbursement Agreement
207.02 EMS Authorization Form UGYFD (fillable) 06-16
207.03 FIRE Authorization Form UGYFD (fillable) 06-16
210.00 Fire Motor Vehicle Report
210.02 Acquired Vehicle Permission Form
211.00 Interview of New Candidates for Membership
212.00 Membership & Intern Application Flow Matrix
212.01 Membership Employment Application
212.02 DHFS Background Information Disclosure Form
213.01 Issued Equipment Inventory
213.02 FH New Member Information
213.03 Confidentiality Statement
214.00 Code of Conduct (Professional Relations, Media Relations and Social Media)
214.01 Social Media article Fire Chief 07-2012
216.00 Facial Hair Policy (SCBA)
216.01 Personal Appearance, Hair Length, Jewelry
217.00 Personally Owned Vehicle (POV) Lights & Siren
217.01 Personally Owned Vehicle (POV) Inspection & Responsible Use Agreement
217.02 Personally Owned Vehicle (POV) Proof of Insurance Form
218.00 Annual Review of Driving Record Certification of Violations
219.00 Workplace Harassement & Complaint Procedure Policy
219.01 Workplace Harassement Complaint Form
221.00 Leave of Absence Policy
221.01 Leave of Absence Request Form
225.01 Emergency Information Worksheet
225.02 PSOB Beneficiaries Designation Form
226.00 VFIS Handbook of Insurance Benefits & Beneficiary Form
227.00 Incident Response Requirement
228.00 Compensation Paid on Call Plan
228.01 Compensation (Memo 04-17-04 Time Punch – Fire Calls MVA)
228.02 FH Personnel Incident Response Sign In Sheet
228.03 FH Personnel Business Training Activity Sign In Sheet
228.04 Associate Time Sheet.pdf
230.00 Janitorial Job Description 8-29-05
231.00 Clerical Job Description 10-01-00
232.00 AC EMS Job Description 04-05-11
240.00 State of Wisconsin Act 140, 2009
240.01 Excused Absence From Work Form
240.02 Employer Letter (example)
245.00 Disciplinary Action Policy
250.00 Officer Qualities, Requirements & Expectations
280.00 Associate Membership Program
280.01 Associate Membership Program Yearly Renewal Agreement
280.02 Weekly EMS Fire Intern Associate Station Duties
300.03 1st Size-up Explanation
301.00 Carbon Monoxide CO Response
301.01 Carbon Monoxide CO Checklist
302.00 Apparatus Placement at Fire & Rescue Scenes
303.00 Truck Company Assignments – drawing
303.09 Non Verbalized Commands
304.00 Engine Company Assignments – drawing
304.01 Engine Company Deployment
304.05 Outside Vent (OV) Procedures
304.09 Non Verbalized Commands
305.03 Hospital Pack Hose Pack Repacking
305.04 Minimum Target Flow Rates
311.00 Support of Automatic Sprinkler Systems
326.00 Self Contained Breathing Appartus SCBA Usage
380.00 Orientation of Fire Members
380.01 Orientation of Fire Members – Self Directed Learning Sheets
400.00 Patient Care Protocols 2019
400.03 Lidocaine Drip Administration Guidelines
402.00 Ambulance New Member Rules & Candidate Riding Assignments
402.02 EMS Ride Along Request Form
405.00 Medical Control & Quality Management Program
407.00 Racine Area EMS – On Scene Worksheet
425.00 Daytime Schedule Program
450.00 EMS Dispatch and Response Policy
450.01 Tiered Dispatch Guideline
455.00 Hospital Destination Determination
455.01 Billing Authorization & Privacy Acknowledgment Signature Form (rev. 01-08) Use pg 1 only
455.02 Notice of Privacy Practices (rev. 12-07)
460.00 EMS Response Cancellation
465.01 Release of Liability Form
465.02 Multiple Patient Release Form
470.01 Discharge Tracking Record – Incident Command
470.02 Discharge Tracking Record – Medical Unit
470.03 Participation Release of Liability and Indemnity Agreement
475.00 Controlled Substance Policy Procedure
475.02 Record of Seal Replacement
475.10 Dilaudid 333 Inventory Log
475.11 Dilaudid 334 Inventory Log
475.12 Dilaudid 335 Inventory Log
475.13 Fentanyl 333 Inventory Log
475.14 Fentanyl 334 Inventory Log
475.15 Fentanyl 335 Inventory Log
475.16 Lorazepam/Ativan 333 Inventory Log
475.17 Lorazepam/Ativan 334 Inventory Log
475.18 Lorazepam/Ativan 335 Inventory Log
475.19 Morphine 333 Inventory Log
475.20 Morphine 334 Inventory Log
475.21 Morphine 335 Inventory Log
475.22 Valium 333 Inventory Log
475.23 Valium 334 Inventory Log
475.24 Valium 335 Inventory Log
475.25 Versed 333 Inventory Log
475.26 Versed 334 Inventory Log
475.27 Versed 335 Inventory Log
480.00 Orientation of EMS Members
480.01 Orientation of EMS Members – Orientation Form
480.02 Orientation of EMS Members – Patient Encounter, Run Evaluation Form
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