Shift Report Entry – Centreville Volunteer Fire Department

Your Email Address *

Used to send confirmation of shift report.

Shift Start Time *

Date

Time

Shift End Time *

Date

Time

Vehicle Used *

Unit Identifier for Shift *

Driver *

Officer in Charge (OIC) *

Other (3rd)

Other (4th)

Number of Calls Run *

Overview of Calls Run

Please say a few words about each call. Do NOT include any PII.
Example: "Call 1: MVA on Rt 28, transported one BLS patient. Call 2: Added on to MEDICAL, Medic transported, back in service."

General Shift Notes *

Please provide general commentary about how the shift went. Good model: What went well? What didn't go well? What would you do differently next time?

Training Accomplishments

Please say a few words about any training completed during the shift, to include AIT/DIT training or progress in a BLS Internship Task Book.

Was an Electronic Vehicle Inspection form completed? *

Yes
No

Use paper FRD-167 if Intranet is down.

Were any vehicle deficiencies noted? *

Yes
No

Were the vehicle deficiencies logged in M5? *

Yes
No

If no, explain below.

Please describe the vehicle deficiencies and actions taken. *

Was an FRD-205 (EMS Equipment Daily Check Sheet) completed? *

Yes
No

Was an FRD-036 (SCBA Field Inspection) completed for each SCBA onboard? *

Yes
No

Was an FRD-212 (ALS Med Inventory) completed? *

Yes
No

Was the station logbook stamped (blue ink) and filled out completely? *

Yes
No

Do you attest that all BLS and/or ALS medications were properly secured at the end of the shift? *

Yes
No

Medications shall be LOCKED UP at the end of the shift. If the rollup will not lock, find another way to secure the meds- such as placing in the radio lockup or EMS closet. This includes the "band-aid box" in the BLS bag!

Is vehicle ready for service? *

Yes
No

"Ready for service" includes vehicle cleaned inside and out, trash bins emptied, and fuel above 3/4 tank.

Please explain why the vehicle is not ready for service. *