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  • EMT
    • Initial Certification Policy
    • Recertification Policy
    • EMT Reinstatement
    • Challenge Policy
    • Credentialing Forms
  • EMT-P
    • Accreditation Policy
    • Reverification Policy
    • Credentialing Forms
  • M.I.C.N.
    • Authorization Policy
    • Reauthorization Policy
    • Challenge Policy
    • Credentialing Forms
  • Protocols
    • Policy and Protocol App
    • Policy and Protocol Manual
      • CURRENT Manual
  • Education
    • Policy & Protocol Updates
      • Current Year
      • Archived Years
      • Trial Study - TXA (Archived)
    • CE Calendar
    • Training Programs
    • Archived Education
  • Programs
    • Ambulance Permits
    • Public Access Defibrillation
    • STEMI
    • Stroke
    • Trauma
  • Documents
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    • Reports | Archived
    • Memos
    • Contracts
    • EMCC
    • EMS Plan
    • Ordinances
    • PMAC
    • Reporting Forms
    • System Strategic Plan
    • System Evaluation
    • Continuous Quality Improvement
    • Reports | Current (New)
  • Credentialing
    • Online Credentialing Portal
    • Credentialing FAQs
    • Discipline & Enforcement
  • Contacts
    • REMSA Contacts
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Home  /  Documents  /  Reporting Forms


Credentialing Forms

      EMTs
  • BLS Skills Competency Verification (Form Only)
  • BLS Skills Competency Verification (Complete Packet)
  • EMT Request for Live Scan
  • EMT Challenge Examination
      Paramedics & MICNs
  • ALS Skills Competency Verification (Form Only)
  • ALS Skills Competency Verification (Complete Packet)
  • MICN Field Observation (Ride Out)
  • Verification of Eligibility for MICN Challenge
      General
  • Vaccine Administration Skill Verification Form (LOSOP)

CQI Forms

  • Exceptional Performance Report
  • REMSA Law Enforcement Use of Naloxone Reporting Form
  • Stroke Patient Registry Form (Non-Stroke Center)
  • Trauma Patient Registry Form (Non-Trauma Center)
  • Unusual Occurrence Review Reporting Form

ICS Forms

  • ICS Forms (Complete Booklet)
  • MCI Forms (305 / 306 / 308 / 310 / 312)

Public Access Defibrillation Forms

  • PAD Application
  • PAD Event Summary

Reporting Forms

  • Alternative Medication / Expired Medication Waiver Form
  • Code 3 Notification
  • Communicable Disease Exposure Request Form
  • DEA Report of Lost or Stolen Controlled Substances
  • Escape Hood Notification
  • Nerve Agent Antidote Kit (NAAK) Notification
  • Optional Equipment Authorization Application
  • Radio Communication Failure Notification
  • Suspected Adult / Elder Abuse Report
  • Suspected Child Abuse Report


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Emergency Management Department


Phone: (951) 358-5029

 


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