Transcription of Medium Rescue Certification 2012 V - ncarems.org
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Medium Rescue Certification 2012 V - ncarems.org
1 Revised: 07/01/12 NORTH CAROLINA ASSOCIATION OF Rescue & EMERGENCY MEDICAL SERVICES, INC. BOX 1914, GOLDSBORO, 27533-1914 TELEPHONE: 919/736-0506 FAX: 919/736-7759 E-MAIL: CERTIFICATE OF ELIGIBILITY Medium Rescue ** PLEASE PRINT OR TYPE NAME OF DEPARTMENT_____DATE_____ MAILING ADDRESS_____ST. ADDRESS_____ CITY_____STATE_____ZIP_____COUNTY_____ DEPARTMENT EMAIL ADDRESS_____ COMM CENTER PHONE #( )_____BUSINESS PHONE #( )_____ DEPARTMENT CELL PHONE #( )_____FAX # _____ CAPTAIN/CHIEF_____EMAIL ADDRESS_____ WORK PHONE #( )_____ HOME PHONE #( ) _____CELL #( )_____ SECRETARY_____EMAIL ADDRESS_____ WORK PHONE #( )_____HOME PHONE #( ) _____CELL #( )_____ DOES YOUR SQUAD PROVIDE? Rescue ONLY___EMS ONLY___EMS/FIRE_____EMS/RESCUE___EMS/FIR E/RESCUE____ FIRE/RESCUE_____ COPY OF STATE CHARTER & CONTRACT WITH CITY / COUNTY, INDICATING DISTRICT OF AUTHORITY, MUST ACCOMPANY THIS CERTIFICATE OF ELIGIBILITY Medium Rescue : Inspectors Initials _____ Revised: 07/01/12 2 DEPT.
Medium Rescue: Inspectors Initials _____ Revised: 07/01/12 6 J. TRAFFIC AND CROWD CONTROL AND HAZ-MAT EQUIPMENT
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