Forms

Fire and EMS Administrative Forms

  1. Active 911 Form (PDF)
  2. Annual Driver List (PDF)
  3. Application for Use of Training Center (PDF)
  4. Blank Accountability Tag Order Form (PDF)
  5. Department Safety Self Inspection Form (PDF)
  6. Driver Training Log
  7. Engine DO Release Program (DOCX)
  8. Gas Meter Repair Form (PDF)
  9. ID Badge Request Form (PDF)
  10. Infectious Disease Exposure Report Form (PDF)
  11. Knox Box Audit Form (PDF)
  12. Knox Box Entry Form (PDF)
  13. Knox Box List for Facilities (PDF)
  14. Knox Box Personnel Approval Form
  15. Red Cross Smoke Detector Form (PDF)
  16. Release to Practice-Precepting Form (PDF)
  17. Request for SCBA Repair Form (PDF)
  18. Ride-A-Long Form (PDF)
  19. Save and Significant Incident Form (PDF)
  20. SCFR Driver Release, Pump Manual and Station Apparatus Specs (PDF)
  21. SCFR Dry Hydrant Inspection Form (PDF)
  22. Shenandoah County Burning Regulations
  23. Shenandoah County Dry Hydrant Manual (PDF)
  24. Shenandoah County Job Application
  25. Toxic Exposure Form (PDF)
  26. Training Registration Form (PDF)
  27. VFIS Beneficiary Designation Form (PDF)
  28. VSP Criminal History Form (PDF)

Department of Emergency Communications Forms

  1. ECC Radio Complications Form

Injury Forms

  1. VA Line of Duty Act Claim for Death Benefits (PDF)
  2. VA Line of Duty Act Claim for Disability (PDF)
  3. VA Line of Duty Act Claim for Health Insurance (PDF)

QA / QI Forms

  1. Cardiac Arrest QI Form (PDF)
  2. EMS Patient Refusal Form (PDF)
  3. Generic Skills and Procedure Form (PDF)
  4. King Airway Form (PDF)
  5. Shortness of Breath Form (PDF)
  6. Spinal Immobilization Form (PDF)

EMS Billing Information Requests

  1. Ambulance HIPAA Notice (PDF)
  2. EMS Insurance Billing Information (PDF)
  3. EMS MC HIPAA Privacy Notice (PDF)
  4. Request for EMS Transport Fee Waiver Form (PDF)
  5. SCFR HIPAA Privacy Notice (PDF)
  6. Release of Protected Health Information
  7. Release of Protected Health Information Fillable

ICS Forms

  1. ICS Form 201-Incident Briefing (DOCX)
  2. ICS Form 202-Incident Objectives (DOCX)
  3. ICS Form 203-Organization Assignment List (DOCX)
  4. ICS Form 204-Assignment List (DOCX)
  5. ICS Form 205-Incident Radio Communications Plan (DOCX)
  6. ICS Form 206-Medical Plan (DOCX)
  7. ICS Form 207-Incident Organization Chart (DOCX)
  8. ICS Form 208 -Safety Status Message (DOCX)
  9. ICS Form 209-Incident Status Summary (DOCX)
  10. ICS Form 210-Resource Status Change (DOCX)
  11. ICS Form 211-Incident Check In List (DOCX)
  12. ICS Form 213-General Message (DOCX)
  13. ICS Form 214-Activity Log (DOCX)
  14. ICS Form 215A-IAP Safety Analysis (DOCX)
  15. ICS Form 215-Operational Planning Worksheet (DOCX)
  16. ICS Form 218-Support Vehicle Equipment Inventory (DOCX)
  17. ICS Form 219s-T Cards (DOCX)
  18. ICS Form 220-Air Operations Summary (DOCX)
  19. ICS Form 221-Demobilization Checkout (DOCX)
  20. ICS Form 225-Incident Personnel Performance Rating (DOCX)

Shenandoah County Standard Operating Guidelines

  1. SOGs Entire Manual 1.2026