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| 2156 Sierra Way, San Luis Obispo, CA 93401 ~ Phone: 805.788.2511 ~ Fax: 805.788.2517 ~ Hours: Monday - Friday ~ 8:00 a.m to 5 p.m. |
AED - Public Access
AED Public Access Program Agreement
AED Public Access Site Notification
AED Public Access Use Report
AED Public Access Program Agreement
AED Public Access Site Notification
AED Public Access Use Report
AED - Public Safety
AED Public Safety Annual Data Report
AED Public Safety Annual Update
AED Public Safety Provider Application
AED Public Safety Skills Check
AED Public Safety Use - Patient Report
AED Public Safety Annual Data Report
AED Public Safety Annual Update
AED Public Safety Provider Application
AED Public Safety Skills Check
AED Public Safety Use - Patient Report
CE Provider
CE Provider Application
Sample CE Course Completion Certificate
Sample CE Course Evaluation
Sample CE Course Roster
CE Provider Application
Sample CE Course Completion Certificate
Sample CE Course Evaluation
Sample CE Course Roster
INCIDENT REPORT
Opportunity for Improvement/Incident Report
Opportunity for Improvement/Incident Report
EMS Personnel Exposure Forms
Contagious Disease Exposure Report
EMS Personnel Exposed To Blood and/or
Body Fluids - Hospital Emergency
Room/LEMC
Contagious Disease Exposure Report
EMS Personnel Exposed To Blood and/or
Body Fluids - Hospital Emergency
Room/LEMC
Controlled Substance Forms
Controlled Substance Use Quarterly Report
DEA Power of Attorney
Controlled Substance Use Quarterly Report
DEA Power of Attorney
EMT FORMS
DMV Driving Record Authorization
EMT Skills Competency Verification Please
check instructions carefully to determine the
form. If an unqualified person signs off your
skills, you will be required to re-do them.
Live Scan Fill in blue boxes as indicated
DMV Driving Record Authorization
EMT Skills Competency Verification Please
check instructions carefully to determine the
form. If an unqualified person signs off your
skills, you will be required to re-do them.
Live Scan Fill in blue boxes as indicated
MICN FORMS
MICN Base Hospital Orientation Checklist
MICN Base Hospital Proctoring
MICN Field Orientation Checklist
MICN Base Hospital Orientation Checklist
MICN Base Hospital Proctoring
MICN Field Orientation Checklist
Communications Failure Report
Paramedic Student Intern Packet All student intern applicants must be approved by the EMS Agency
before starting field internship. Application must be complete and accompanied by all required
documentation before review by the EMS Agency.
Paramedic Field Evaluation Packet
All Paramedics new to San Luis Obispo County must be employed by a local ALS provider and
approved by the EMS Agency to start field evaluation. A field evaluation with a Field Training Officer
must be completed before accreditation is granted.
POLST Form
POLST Information Website
Paramedic Student Intern Packet All student intern applicants must be approved by the EMS Agency
before starting field internship. Application must be complete and accompanied by all required
documentation before review by the EMS Agency.
Paramedic Field Evaluation Packet
All Paramedics new to San Luis Obispo County must be employed by a local ALS provider and
approved by the EMS Agency to start field evaluation. A field evaluation with a Field Training Officer
must be completed before accreditation is granted.
POLST Form
POLST Information Website
| © SLO County EMS Agency 2011, 2012 Last updated 02/14/2012 |
Other MISC. Information
Common EMS Abbreviations & Acronyms
Common Abbreviations used on Patient Care Reports
Common EMS Abbreviations & Acronyms
Common Abbreviations used on Patient Care Reports
RECALLS & ALERTS
12/21/11
Silicone Endocardial Defibrillation Leads
6/07/2011
Oridion Medical and Philips Healthcare Microstream CO2 Filterline (FilterLine H Set
Infant/Neonate, VitaLine H
5/11/2011
Defibtech Lifeline and ReviveR Automated External Defibrillators(AEDs): Recall - Software
Defect May Cancel Shock
05/06/2011
Needleless Pre-filled Glass Syringes:Drug Safety Communication - Compatibility Problems with
Needleless Intravenous Access Systems
05/02/2011
Defibtech Announces a Voluntary Recall of DDU-100 series AEDs
04/21/2011
Atwater Carey First Aid Kit Consumers Regarding Triad Group’s Povidone Iodine Prep Pads
02/28/2011
Triad Group Alcohol Preps, Swabs and Swab Sticks
Triad Group Lubricating Jelly - Brand Names Sold Under Include: Triad, McKesson, Select,
Cardinal, Imco, Schein and Novation
7/02/2010
LIFEPAK 20 and LIFEPAK 20e External Defibrillator/Monitors by Physio-Control Inc.: Class I Recall
Due To Power Supply Failure
6/14/2010
Defibtech DBP-2800 Battery Packs used in Lifeline AED and ReviveR AED: Recall
10/05/2009
Philips Heartstart Fr2+ Automated External Defibrillators - Recall
12/21/11
Silicone Endocardial Defibrillation Leads
6/07/2011
Oridion Medical and Philips Healthcare Microstream CO2 Filterline (FilterLine H Set
Infant/Neonate, VitaLine H
5/11/2011
Defibtech Lifeline and ReviveR Automated External Defibrillators(AEDs): Recall - Software
Defect May Cancel Shock
05/06/2011
Needleless Pre-filled Glass Syringes:Drug Safety Communication - Compatibility Problems with
Needleless Intravenous Access Systems
05/02/2011
Defibtech Announces a Voluntary Recall of DDU-100 series AEDs
04/21/2011
Atwater Carey First Aid Kit Consumers Regarding Triad Group’s Povidone Iodine Prep Pads
02/28/2011
Triad Group Alcohol Preps, Swabs and Swab Sticks
Triad Group Lubricating Jelly - Brand Names Sold Under Include: Triad, McKesson, Select,
Cardinal, Imco, Schein and Novation
7/02/2010
LIFEPAK 20 and LIFEPAK 20e External Defibrillator/Monitors by Physio-Control Inc.: Class I Recall
Due To Power Supply Failure
6/14/2010
Defibtech DBP-2800 Battery Packs used in Lifeline AED and ReviveR AED: Recall
10/05/2009
Philips Heartstart Fr2+ Automated External Defibrillators - Recall
APPLICATION
EMS Personnel Application For EMT,
Paramedic and MICN applicants. Form
must be complete to be accepted.
EMS Personnel Application For EMT,
Paramedic and MICN applicants. Form
must be complete to be accepted.
Airway Management
Airway Management
Airway Management