Lisbon Fire Department Standard Operating Guidelines and Policies

Automatic Mutual Aid

1. 
   2663/2662 (for water supply. A minimum of 2 Firefighters.)
   
2. 
   2691
   
3. 
   2693
   

intact as a crew.

1. Perform back in service checks according to the “Back in Service Checklist” form.

Document or rectify any problems noted. If there is a problem that cannot be taken care of at that time, a work order report must be filled out and all information will be written down pertaining to the problem. If the problem entails that the apparatus be taken out of service, an “Out of Service” tag will be attached to the steering wheel and the keys removed (where applicable). It will be the responsibility of the driver/operator to make sure that the correct personnel are notified of the situation. All work orders will be put into the proper bin on the dispatch desk.

This procedure establishes guidelines for training of fire suppression personnel engaged in structural firefighting operations under live fire conditions as set forth in NFPA 1403. This procedure focuses on training for coordinated interior fire suppression operations with a minimum exposure to risk for the participants. The evolutions conducted within these guidelines shall be managed by means of a documented incident management system. The line of authority shall be made clear to all participants in order that both expected and unforeseen situations will be managed with the most efficiency possible and that reasonable margins of safety will be provided.

b. Any building that is considered for a structural fire training exercise shall be properly prepared for the live fire training evolution.

This is to include the proper permits that may include the following:

1. 
   demolishing permit
   
2. 
   burn permit
   
3. 
   fire department waiver (which relieves the responsibility off the fire department if the owner tries to collect insurance money etc.)
   

c. The property owner must be the only individual to sign the permits and prior to the burn, the owner must show proof of ownership, cancellation of insurance or a signed statement of nonexistence of insurance.

e. Any exposures that might be damaged by the live fire training shall be properly protected or removed if applicable.

3. Water Supply

b. An area shall be designated to park apparatus and vehicles that are not part of the evolution so as to not interfere with fire ground operations. This area shall be designated for prompt response of apparatus that will be handling true emergencies.

c. Any personnel that respond in their own vehicle (pv) shall park in an area that is not to interfere with operating or staging areas and will be designated by the Incident Commander.

5. Pre-burn Briefing Session(s)

c. A plan shall be prepared for the structure and shall be utilized in the briefing sessions. All interior rooms, hallways and exterior openings shall be indicated on the plan.

d. Prior to conducting any live fire training in the structure, all participants shall have a knowledge and familiarity with the layout of the building in order to facilitate necessary evacuation of the building.

e. Prior to conducting any live fire training in the structure, all participants of the evolution shall be required to have a walk-through of the structure.

4. 
   Visitors allowed to observe operations and allowed within the operations area perimeter shall be escorted at all times and shall be equipped with and properly wear protective equipment.
   

7. Fuel Materials

c. The use of flammable or combustible liquids shall be prohibited for use in live fire training evolutions.

d. The officer/instructor in charge of operations shall assess the selected fire room environment for factors that will affect the growth, development and spread of fire.

e. The officer/instructor in charge of operations shall also monitor fuel loading, including furnishings, wall and floor coverings and ceiling materials.

Note: The training exercise shall be immediately stopped if the officer/instructor determines a potential hazard. The exercise shall continue only when the appropriate actions have been taken to reduce the hazard.

8. Safety

c. The Safety Officer’s responsibilities may include but not limited to the following:

1. 
   prevention of unsafe acts
   
2. 
   elimination of unsafe conditions
   

d. The Safety Officer shall provide for the safety of everyone at the training exercise, this includes visitors and spectators.

e. Sufficient back up lines shall be provided to ensure adequate protection for personnel on the attack lines during live fire training exercises.

g. The officer/instructor in charge shall assign the following:

1. 
   an officer/senior firefighter to each functional crew, which shall not exceed 5 personnel
   
2. 
   an officer/senior firefighter to each “back-up line”
   
3. 
   sufficient additional personnel to “back-up lines” to provide mobility
   
4. 
   an additional officer/instructor for each additional functional assignment
   

h. If the Safety Officer deems it necessary, additional safety personnel shall be placed within the structure to react to any unplanned, threatening situation or condition.

This person shall wear full protective equipment including SCBA and PASS device.

l. A thorough search of the structure shall be conducted to ensure no unauthorized personnel or objects are in the building prior to ignition.

m. It will be the decision of the Incident Command in coordination with the Safety Officer when to ignite any training fires. The Safety Officer shall supervise the ignition officer when the fire is ignited.

n. No person(s) shall be placed inside the building to play the role of a victim.

9. Protective Clothing
a. Each participant that is partaking in the training exercise shall be equipped with full protective equipment including SCBA and PASS device.
b. All participants shall be inspected by the Safety Officer prior to entry into a live fire training evolution to ensure that all protective equipment is being worn properly and is in serviceable condition.

c. All protective gear shall meet the requirements of the NFPA standard applicable for that particular year of manufacture.

1. 
   Instructors shall be at least Instructor Level I to deliver structural firefighting training.
   

2. 
   The ratio of FF’s to officer shall not exceed 5 to 1.
   

3. 
   Other factors such as extreme temperatures (summer), large groups and long duration exercises shall be taken into consideration and additional instructors shall be designated as deemed necessary to ensure proper levels of safety.
   

d. The officer in charge shall try to comply with NFPA 1403 and this guideline to the best of his/her ability.

11. Reports and Records

1. 
   an accounting of the activities conducted
   
2. 
   a listing of instructors present and their assignments
   
3. 
   a listing of all participants
   
4. 
   documentation of any unusual conditions encountered
   
5. 
   any injuries incurred
   
6. 
   any changes in the structure
   
7. 
   the condition of the premises and adjacent are at the conclusion of the training exercise
   

b. A post training critique session, complete with documentation, shall be conducted to evaluate student performance and to reinforce the learning experiences of all participants. At this time, an over all evaluation of the exercise should be done so that any problems encountered can be corrected to prevent them from happening again.

1. 
   Engine (water source)
   
2. 
   Engine
   
3. 
   Ladder Truck
   
4. 
   Rescue/Equipment
   
5. 
   Ambulance
   

Lisbon Fire Department, refer to SOG # 3-1 for apparatus response.

1. 
   2662: Parking lot of south side.
   
2. 
   2663: East side of building.
   
3. 
   2661: South side of building.
   

Conditions such as location of the fire, access to the property, wind direction, and exterior exposures may cause the officer to deviate from positioning the apparatus as specified above. Apparatus placement must always be positioned for the safety of personnel and equipment.

1. 
   Engine (water source)
   
2. 
   Engine
   
3. 
   Ladder Truck
   
4. 
   Rescue/Equipment Truck
   
5. 
   Ambulance
   

Lisbon Fire Department, refer to SOG # 3-1 for apparatus response.

1. 
   2662: Parking lot of south side.
   
2. 
   2663: with 2662
   
3. 
   2661: East Side of building.
   

2663 will stage with 2662. If needed, 2663 will connect a 5-inch supply to 2662 and then proceed with a reverse lay to Silver Spring, staying on the west side of the driveway. If needed, Sussex will then continue the reverse lay to the hydrant by the industrial park.

The first unit on the scene shall establish Incident Command. Command shall relay a brief size-up to the other responding units. Command shall form a fire/smoke investigation of the crew of the first engine company. The crew will investigate any findings inside the building and report any findings to command. Command will then dispatch equipment and personnel needed for that situation.

LISBON FIRE DEPARTMENT

1. 
   2653
   
2. 
   2652
   
3. 
   2688-2681 (Dependant on which station)
   

First out ambulance may respond with one or two EMT’s if other qualified personnel are responding to the scene. This information may be derived from radio, cellular, telephone communications, or pre-established criteria. If one EMT is waiting with an ambulance and they hear a officer or another qualified person go enroute, or if they see a second EMT pulling into the station, they are then required to call enroute. They will then wait for any other personnel that are pulling into the station.

After first ambulance is enroute, and more personnel arrive, they should respond with 2688 or 2681. If only one person is in 2688 or 2681, and you know that there are other people on your group responding, please wait for them and then respond. If a few minutes has passed, or the officer in charge requests, you may respond. Once 2688 or 2681 is enroute and additional personnel arrive at the station, and there are ample personnel already enroute, either stand bye at the station for another call, or contact the officer in charge for direction.
PERSONNEL:
A minimum of one (1) EMT-P will be required for all emergency medical calls. Two (2) EMT-P’s is preferred.

MEDICAL RELEASES:
A Lisbon Fire Department medical release will be used if a patient refuses any medical services, or if after attaining a complete set of vital signs, the patient refuses transport. If the vital signs are unstable, and every attempt to convince the patient to be transported fails, and they are alert and oriented, a release must be signed, and all information documented on a state run report.

Lisbon Fire Department
Station Policy,

Rules and Regulations
Issued 2/26/08
PURPOSE

The Lisbon Fire Department in order to maintain a safe, affable, clean, healthy, and professional atmosphere for the department’s staff; and to assure station integrity and preservation is here-by issuing the following policy. This set of regulations are here by established to guarantee an on-duty crew will be ready to respond to an emergency in the Town with the appropriate tools and mind set. All references to the word “station” in this document apply to both Good Hope Company and Richmond Company.

1. 
   Follow Department SOG manuals, rules & regulations and written directives.
   
2. 
   Always conduct themselves in a manner that creates good order inside the department.
   
3. 
   Keep themselves informed as to the expected responsibilities in station care, duties, and assignments as it pertains to their stay at the station.
   
4. 
   Keep themselves in readiness to perform their duty while at the station, and not absent themselves from duty or place of assignment without specific permission of their superior officer.
   
5. 
   Exercise precautionary measures to avoid unnecessary injury to themselves and others while in the performance of their duty, or stay at the station.
   
6. 
   Notify on-call officer of any sudden illness or injury in which would result in leaving the station or ending your scheduled shift.
   
7. 
   Be concerned and protective of each member’s welfare.
   
8. 
   Be considerate in each member’s rights, and their personal belongings.
   
9. 
   Be courteous and respectful in interacting with all other department members.
   
10. 
    Show courtesy, respect and obedience to superior officers and those performing the duties of a higher rank.
    
11. 
    When assigned to a higher rank, accept the responsibility for performance of the duties of that position.
    
12. 
    Be courteous and respectful in dealings with the public visiting the station.
    
13. 
    Observe the work/recreational/quiet hours as set by the department.
    
14. 
    Obey the law.
    
15. 
    Be careful of department equipment and property. Exercise due caution to avoid unnecessary damage to and/or loss of Fire Department property.
    
16. 
    Promptly notify their immediate supervisor of all matters coming to their attention directly, which significantly affects the interest and welfare of the Fire Department, equipment, and its assets.
    
17. 
    Familiarize themselves with all equipment they may be required to use in the performance of their duty.
    
18. 
    Participate in and obtain confirmation of attendance for all Department provided orientations of station equipment and its correct uses, including exercise apparatus, before stay at station.
    

1. 
   Engage in any activity that is detrimental to the department.
   
2. 
   Fight.
   
3. 
   Engage in any rough-housing, wrestling, or any other inappropriate personal contact.
   
4. 
   Steal.
   
5. 
   Use alcoholic beverages, debilitating drugs, or any substance which could impair their physical or mental capabilities while on duty and or at the station.
   
6. 
   Have in possession while at the station any alcoholic beverages or illegal substances.
   
7. 
   Engage in any sexual activity on or off duty at the station, in any Town owned vehicles, or on any paid department time.
   
8. 
   Engage in any sexually suggestive or offensive type of conduct.
   
9. 
   Engage in any form of sexual harassment.
   
10. 
    Members shall not loan, rent, sell, give away or appropriate for their own use any Fire Department property without permission or authority. This includes, but not limited to, use of copiers, paper, tools, and promotional items.
    
11. 
    Members shall not change or alter the arrangement of firefighting equipment or apparatus without approval.
    
12. 
    Members shall not participate in or retain any knowledge of illegal activity on Town property.
    
13. 
    Tamper with any other member’s items at any time.
    

1. 
   No persons other than members of the Fire Department shall be permitted to ride on the fire apparatus except when authorized to do so by the Fire Chief.
   
2. 
   Members may participate in organized meals. It being in the interest of the employees for the morale of the Department and for the harmonious working relationship between firefighters. This will be a no cost item to the Fire Department as there shall be no contribution to this fund. It shall be the responsibility of each member to contribute their fair share for the daily meals while on duty.
   
3. 
   Members who are on disability leave or who suffer from an ailment that precludes them from active firefighting duties may be placed on light duty upon recommendation of a physician and authorization of the Fire Chief. The authorizing physician shall present a letter to the Fire Department indicating the light duty capabilities of the employee. All light duty assignments will be performed at disabled accessible areas of the station.
   
4. 
   Only Town of Lisbon employees may utilize exercise equipment located at any Fire Department station.
   
5. 
   At 22:00 the fire station will comply to a quiet time status, doors closed, lights dimmed, bay lights out, yard lights out, no loitering in parking lot, quiet time upstairs, and it is expected that no one group or persons will negatively affect any other member from resting/sleeping.
   
6. 
   All personnel before going off duty shall remove their firefighting turn out gear from the apparatus and place it in its proper location.
   
7. 
   All Fire Department phones portable, vehicular and stationary shall be used exclusively for Fire Department business. All other calls are to be made on the private phones.
   
8. 
   Snow shoveling - On duty personnel are responsible for assuring appropriate paths are cleaned at all sidewalks and approaches to overhead doors. Safe walkways shall be maintained for visitors and other personnel.
   
9. 
   Lockers are to be kept closed at all times. When a member is off duty, the lockers shall be locked. A key shall remain in the possession of the occupant plus a spare key with the Fire Chief and/or Station Officer. Lockers shall be kept in a clean and orderly fashion at all times.
   
10. 
    Members shall strictly adhere to the Town’s/Department’s internet/computer use policies.
    
11. 
    Staff dorms are available to the on-call FF/EMTs on a first come first serve basis. Richmond Co. does house an officer bunk, which will be reserved for such. The rooms shall be occupied at each station as assigned by the group officer. Remaining rooms may be occupied by other Lisbon staff, or a ride-along that is pre-approved by the Chief of the Department. Non-on-call members will be supplemental personnel to the on-call group and will not interfere with the on-call members, but lend assistance as requested. All overnight residents will be responsible to fill out the log in each bunk room, before and after the stay. Each member is responsible for providing and for proper maintenance (laundering, etc.) of their own bedding. Mattress covers will be supplied by the Department, but shall be left in a clean condition for next occupant.
    
12. 
    Lockers: While members are staying at the station they may have use of a locker in the appropriate locker room. The lockers shall be emptied after each stay if the number of lockers available drop below an acceptable level. Members shall keep their locker neat and orderly. Locker doors shall normally be kept closed. Locks keep on the lockers shall be clearly marked with the owner’s name. All items are to be removed at the end of each shift if the demand for lockers exceeds the amount available.
    
13. 
    Housekeeping will be every member’s responsibility and all will accept details assigned to them.
    
14. 
    No boots or turn-out gear on carpeting at any time.
    
15. 
    Refrain from food and drink in training room. Absolutely, need to clean any spills immediately after each episode, on all carpeted surfaces.
    
16. 
    The washer and dryer at station shall only be used for specific items. The washer/dryer policies will be addressed in a different document.
    
17. 
    Kitchen will be cleaned after each and every meal, with dishes place away in cabinets. No dishes shall be left in dishwasher overnight. Refrigerator items will be removed after each shift, unless appropriately marked that anyone can consume. There will be one specific cabinet space assigned to each of the 6 groups, where dry items could be stored. Condiments shared in refrigerator will be supplied from a kitty created by members participating in meals.
    
18. 
    Outdoor cooking will be kept orderly and the site clean, free of all cigarette butts, and debris.
    
19. 
    Air conditioning/heat will be turned off at any point in which the majority of members present would prefer open windows. An officer will be notified of the status of the air conditioning system.
    

Visitors will not be permitted in the fire station after 22:00 hours unless authorized by the Fire Chief. At other times, visitors will remain in the area of the apparatus floor unless accompanied by Department members. Sitting in or on Department vehicles will not be permitted unless accompanied by a Department member.

At no time will any visitors be allowed in the common hall way accessing any dorm rooms.
SMOKING
Smoking shall be prohibited on all apparatus and at emergency scenes. No smoking will be allowed at any public appearances within close proximity of any Department equipment. No smoking is permitted at any time in Town vehicles, or Town buildings that are heated or air conditioned. Smoking at outside trainings will be allowed at the times the instructor indicates, away from the focus of the training.
PETS
Pets at the station will be kept only in the apparatus bay, or outside on a chain. Owners will provide a cage for confinement in the bay during calls. Owners will be held responsible for the pet and will clean-up all pet droppings on the property. Any complaints will be investigated and handled on an individual basis.
PERSONAL VEHICLES
Members may work on personal vehicles at the station while on unpaid duty. The tasks performed shall be consistent with the type of example activities listed:
1) Wash, wax, cleaning interior of vehicles, using individual’s own supplies.

2) Minor mechanical work.

3) Lubrication, oil changes, and coolant system flushing with proper disposal of waste by member doing the work.

4) Tire rotation.

5) Keys must remain with the vehicle. The vehicle shall be properly supported and the work area shall be properly cleaned after each use.

6) Department tools shall be cleaned and returned to proper locations.

A Fire Department is an emergency agency and it is impossible to formulate Rules, Regulations and Procedures that will provide a guide or solution to every question or problem. It is expected, however, that these Rules, Regulations and Procedures of the Town of Lisbon Fire Department will be sufficiently definitive and comprehensive to guide the responsibilities, obligations and duties of the officers and members of the Town of Lisbon Fire Department.

Lisbon Fire Chief

8-01-04
Lisbon Fire Department Policy
Regarding on call times

The on call times for groups will start at 18:00 and expire at 06:00 on weekdays (Monday through Fridays). There will also be an expected 15 minute overlap of groups at the change time. Therefore the on call group will respond until 06:15. This is to assure coverage when member’s clocks may read differently. On weekend call the start time for Saturday will be 08:00 and end at 08:00 on Sunday. Sunday call time will start at 08:00 and end at 06:15 Monday morning.

Lisbon Fire Chief

considered Scheduled II medications under the Controlled Drugs and Substances Act

of 1970. In accordance with state and federal laws, these medications need to be

regulated by keeping a complete and accurate record of all stocks on hand.

Monitoring of these medications shall be done through the Lisbon Fire Department

Controlled Drug Record, found on each ambulance.

documented on the approved form.

1. With the exception of a minimal amount of controlled drugs stored on the

jump bag, all controlled pharmaceuticals shall be kept in a locked box.

2. All controlled pharmaceuticals transported either to and/or from the hospital

or between either stations, shall be done in a portable locked box. An

inventory log shall accompany this lock box at all times.

3. A daily inventory shall occur.

4. A log shall be kept on each ambulance containing controlled substances.

5. Drugs shall be dispensed according to medical control protocols or under the

direction of the online medical control physician.

6. Amounts used and wasted shall be recorded, along with patient’s name, date,

route, and time of administration.

7. Discrepancies shall be reported to a Lisbon Fire Department manager and

properly documented immediately upon discovery.

8. Discrepancies shall be investigated by the Fire Chief or his designee.

9. The keys for the lock box shall be stored in a smaller combination-type locked

vessel.

I. Daily inventory

a. Daily inventory shall be taken of the following medications:

i. Morphine Sulfate

ii. Hydromorphone (Dilaudid)

iii. Valium (Diazepam)

iv. Versed (Midazolam)

v. Fentanyl Citrate

vi. Geodon (Ziprasidone Hydrochloride)

OG 6.07 - 2

b. The daily inventory shall utilize the sealed tags with numbers. The

controlled substance bin shall have two tags, and the lock box shall have

one tag.

i. A daily “sealed” audit can be completed by one ALS member or

officer. (If two approved members; an ALS member or officer and

a second ALS member or officer; are available for the daily

“sealed” audit, utilize both signatures)

ii. The ALS person, or officer, shall place their initials, print name,

and sign the User Log (right side of sheet).

iii. The ALS person, or officer, shall document the date and the time

the controlled substances were checked.

iv. The ALS person, or officer, checking the daily inventory shall

write “SEALED” across the drug inventory boxes for that day and

also place his/her initials in the Initials #1 box.

v. The ALS person, or officer, checking the daily inventory shall

mark “AUDIT” in the patient name/comment section of the log

sheet.

vi. The ALS person, or officer, then shall document the lock box seal

corresponding boxes located on the log.

vii. If a discrepancy is found between the daily “sealed” audit and the

previous audit, refer to the Re-Stock/Discrepancy section.

a. These procedures shall be followed when starting a new log following the

previously completed log.

i. The ALS person starting the log shall be accompanied by a second

ALS person, or officer and both members shall perform the task of

starting and verifying the new log.

ii. Both members shall mark their initials, print name, and sign in the

User Log section of the form.

iii. First line of new log (Carry-over of counts from previous log):

1. Date and time shall be completed.

2. The counts of each medication shall be filled in from the

counts located on the previous log.

3. Initials #1 and Initials #2 shall be completed by both

members.

iv. Second line of new log (Re-Count/Re-Seal Audit shall be

performed):

1. Date and time shall be completed.

2. The lock box and controlled substance bin shall be opened

and the actual count of each medication is to be

documented in their corresponding boxes.

OG 6.07 - 3

3. The expiration date on each medication shall be checked.

If a medication is expired, see section on Use and Re-Stock

Procedures.

4. Initials #1 and Initials #2 shall be completed by both

members.

5. The lock box and controlled substance bin shall then be resealed

with new tags and the new lock box seal and

controlled substance bin numbers are to be documented.

v. The actual count of medication (second line), shall correspond with

the carried over from previous sheet numbers (first line).

1. If there is a discrepancy between these two lines, refer to

the Re-stock Breakage/Discrepancy section below.

a. ALL actions related to usage shall be entered on a separate line.

b. Every time a seal is broken, all medications shall be counted and

documented prior to re-sealing the bin and lock box by an ALS person and

officer, or 2nd ALS person.

c. The expiration date of each medication shall be checked.

d. List the date, time administered, and amount used in the “used” column.

e. Enter the patient name in the log with the amounts used / wasted.

f. The amount of medication used and subtracted, shall be documented in red

ink.

his/her name for each medication, and print name in the name column.

h. All wasted medications shall be witnessed by a second ALS person, or

officer, who shall then initial his/her name next to ALS person

administering the medication.

i. If an instance of only one ALS member is present and not a second

ALS member or officer is present, the most senior member shall

initial as the second person verifying wasting and documenting.

i. Expired medications shall be wasted by one ALS person and an officer or

2nd ALS person.

j. Before re-sealing, a separate line shall be completed for an audit of the

actual total amounts of controlled substances.

k. The User Log section of the form shall be filled in by each member

completing task.

IV. Re-stock Breakage / Discrepancy

a. An officer or EMS Captain shall be notified as soon as possible.

b. Identify in the “use” column, the number of medications which were

broken or inconsistent.

c. Write Breakage or Discrepancy in the patient name/comment section.

d. The ALS person shall initial, print, and sign their name. A Second ALS

person, or officer, shall also initial, print, and sign their name as witness.

e. Document the incident on a “Controlled Substance Incident” form and

submit to the EMS Captain AND Fire Chief with both names of the ALS

person and witness.

OG 6.07 - 4

f. Re-stocking controlled substances shall be done by an ALS person and an

officer, or 2nd ALS person. Re-Stocking, or adding medications, shall be

done in RED ink. Both personnel shall initial, print, and sign their name.

g. Before re-sealing, a separate line shall be completed for an audit of the

actual total amounts of controlled substances.

h. If re-stocking requires the transportation of controlled substances from

CMH and/or between either station, refer to the Transporting section.

a. All controlled substances transported from CMH and/or between either

station; must be done in a portable locked box.

b. An inventory log shall accompany this box at all times.

c. Two signatures shall be required to either stock or take medications out of

the portable locked box.

d. Any additions or subtractions of inventory from the locked box shall be

done in RED ink.

e. From CMH to LFD

i. An ALS member shall be designated to acquire the controlled

substance order from CMH.

ii. The ALS member and a CMH Inpatient Pharmacy employee shall

verify and document the controlled substances being placed in the

lock box.

iii. One line shall be designated for the addition of controlled

substances; done in red ink.

iv. A second line shall be designated for an audit of the actual count

contained within the box.

v. The expiration date of each medication shall be checked.

vi. Date and time shall be documented.

vii. Initials #1 and Initials #2 shall be completed by both members.

viii. The User Log section of the form shall filled in by each member

completing task.

f. Between Apparatus

i. The ALS member and an officer, or 2nd ALS member shall both be

present for the exchange to occur.

ii. If necessary, the ambulance needing and/or supplying medications

to the other ambulance shall be driven to the necessary station for

the exchange to occur.

iii. If daily audit is not complete, a daily audit must be completed prior

to exchange of medication.

iv. On each ambulance log pertaining to exchange:

1. One line shall be designated for the addition and/or

subtraction of controlled substances; done in RED ink.

2. A second line shall be designated for an audit of the actual

count contained within the box.

3. The expiration date of each medication shall be checked.

4. Date and time shall be completed.

OG 6.07 - 5

5. Initials #1 and Initials #2 shall be completed by both

members.

6. The User Log section of the form shall filled in by each

member completing task.

7. All necessary bins and boxes shall be re-sealed and tag

numbers shall be documented.

VI. Completed forms

a. The log start and end date along with the counts to be carried over shall be

completed before submission of the form.

b. Completed forms shall be submitted to the EMS captain for verification of

proper documentation.

c. The EMS captain shall verify completeness with the Assistant Chief or

Fire Chief, or their designee.

d. The EMS captain and/or the Assistant Chief, Fire Chief, or designee, shall

document and sign verifying their review of submitted forms.

e. The EMS captain is responsible for maintaining completed logs.

f. A third party audit shall be completed every six months.

g. All logs are to be kept for a minimum of 7 years.

OG 6.07 - 6

LISBON FIRE DEPARTMENT

Controlled Substance Incident

Explanation / Resolution

Date

Unit

Other people involved

Nature of report Discrepancy Breakage Contamination Other (circle one)

Statement of events:

____________________________________ ___________

Signature Date

____________________________________ ____________

Witness Date

____________________________________ ____________

Reviewed By Date

08-01-04
Lisbon Fire Department Policy

Douglas J. Brahm

Lisbon Fire Chief