Fillable Manifest Ambulance Manifest- Ambulance Manifest (Commonwealth of Massachusetts)

Fill Online, Printable, Fillable, Blank Manifest Ambulance Manifest- Ambulance Manifest (Commonwealth of Massachusetts) Form

Use Fill to complete blank online COMMONWEALTH OF MASSACHUSETTS (MA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Manifest Ambulance Manifest- Ambulance Manifest (Commonwealth of Massachusetts)

On average this form takes 11 minutes to complete

The Manifest Ambulance Manifest- Ambulance Manifest (Commonwealth of Massachusetts) form is 1 page long and contains:

  • 1 signature
  • 24 check-boxes
  • 28 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
AMBULANCE-MANIFEST
RESOURCE: ( ) TASK FORCE NUMBER________ LEADER_______________________________
( ) STRIKE TEAM NUMBER________LEADER______________________________
( ) SINGLE RESOURCE NAME____________________________________________
INCIDENT NAME: ______________________________________________
REPORTING LOCATION________________________________________
DATE____/______/_____ TIME______________HRS (24 HOUR TIME)
DEPARTMENT PROVIDING RESOURCE: _________________________
RADIO CALL SIGN: ________________ CMED CALL SIGN_____________
CELL PHONE: ______________________________ CMED RADIO: UHF ( ) VHF ( )
AMBULANCE LEVEL: BLS ( ) INTERMEDIATE ( ) ALS ( )
OTHER INFORMATION:
PERSONNEL: CREDENTIALS:
1.____________________________________________ EMT EMT I PARAMEDIC
2.____________________________________________ EMT EMT I PARAMEDIC
3.____________________________________________ EMT EMT I PARAMEDIC
4.____________________________________________ EMT EMT I PARAMEDIC
ADDITIONAL RESOURCE INFORMATION:
INITIAL ASSIGNMENT: ______________________________________________________________
DEMOBILIZED: TIME: _________HRS DATE: _____/______/_______
DEMOBILIZE APPROVAL: __________________________________ICS-221 YES ( ) NO ( )
IC: ( ) OPERATIONS: ( ) PLANNING: ( ) LOGISTICS: ( )
12/05/07REV01
click to sign
signature
click to edit
85
Appendix I Resource Check-In
1. SINGLE RESOURCES:
A. Provide an appropriate Manifest for the resource to Staging Manager or Resource
Check-in recorder.
B. Resource Unit creates or adds to the ICS 211 to show the single resource.
C. Resource maintains its own ICS 214 for activities.
2. TASK FORCE OR STRIKE TEAM
:
A. Task Force Leader provides a Manifest for each unit in the Task Force or Strike
Team including Leader’s vehicle to Staging Manager or Resource Check-in
recorder.
B. Resource Unit creates or adds to the ICS 211 to show the Task Force or Strike
Team information.
C. Task Force/Strike Team Leader will maintain an ICS 214 for the activities of the
units.
D. Each Unit in the Task Force/Strike Team maintains its own ICS 214 as required
by the Leader.
3. STAGING MANAGER
:
A. Uses manifests to select equipment and/or skills to fill requests from the
Operations Chief or Incident Commander where incoming resources are reporting
directly to Staging.
B. Provides the manifests or copies to the Resource Unit Check-In Recorder to
complete check-in.
4. RESOURCE UNIT: (Check-in/Status Recorder)
A. Records check-in information on Check-in Lists ICS 211.
B. Maintain and post the current status and location of all resources (T-Card)
C. Attach the Manifests to the Resource T Card for quick reference or have them
close at hand for special reference.
D. Prepare and Maintain the Command Post display (to include organization chart
and resource location and deployment.
E. A Check-in/Status Recorder reports to the Resource Unit Leader and assists with
the accounting of all incident-assigned resources.
NOTE: MANIFESTS ARE IN TRIPLICATE: LEADER COPY FOR ACCOUNTABILITY,
STAGING COPY, RESCOURCE COPY.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Manifest Ambulance Manifest- Ambulance Manifest (Commonwealth of Massachusetts)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 27 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document