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Fire Rescue Aerosolized Procedure Report Form

Used when Fire Rescue crews use an aerosolized procedure on patients. This is a two part form. The first part is for the Lead Medic or Battalion Chief to fill out. There is a separate hidden section which gets emailed to the EMS Chief. They then edit the hidden section for their own updated information.

Lead Medic or Battalion Chief Information

Email*

Date of Procedure*

Patient Name*

Patient Age*

Patient Gender*

Patient Weight*

Medication Used*

Dosage*

Route of Administration*

10.

Duration of Procedure*

11.

Procedure Notes

Description:This Fire Rescue Aerosolized Procedure Report Form is used by Fire Rescue crews when they perform an aerosolized procedure on patients. It is a two-part form that includes a section for the Lead Medic or Battalion Chief to fill out. Additionally, there is a separate hidden section that is emailed to the EMS Chief, who can then edit it with their own updated information.

Fire Rescue Aerosolized Procedure Report Form is an essential tool for Fire Rescue crews when they perform an aerosolized procedure on patients. This two-part form includes a section for the Lead Medic or Battalion Chief to fill out, as well as a separate hidden section that is emailed to the EMS Chief. The EMS Chief can then edit the hidden section with their own updated information. This form ensures that all necessary information is recorded and communicated effectively between the Fire Rescue crew and the EMS Chief. By using this form, Fire Rescue crews can improve their efficiency and effectiveness in responding to emergencies.

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Item Code*

Item Category*

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Were any hazardous materials involved?*

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Item Name*

Item Code*

Item Category*

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Describe the near-miss incident*

Provide background information*

Were any hazardous materials involved?*

Chemicals

Explosives

Radioactive materials

Other

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Employee Name*

Employee ID*

Date of Injury*

Select date

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Full Name*

Phone Number*

Location*

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What is your email address?*

What did you like about the lesson?*

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Staff Name*

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Start Date*

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Student First Name*

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Student ID Number*

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