Fire Department Forms

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Last Updated on Thursday, 17 November 2016 11:35

transparentPullman Fire Department
Department Forms

Ambulance Forms
icon Notice of Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

icon General Transport Information Form If you had medical insurance coverage at the time of your ambulance transport print this form, complete it, and return it to the City of Pullman Ambulance Department.

icon Motor Vehicle Accident Insurance Form If your ambulance transport was related to an automobile accident print this form, complete it, and return it to the City of Pullman Ambulance Department.

icon Employment Accident Insurance Information Form If you have an employment related injury print this form, complete it, and return it to the City of Pullman Ambulance Department.

icon Medical Records Release Form Authorization for the release of protected health information (for billing purposes). Print this form, complete it, and return it to the City of Pullman Ambulance Department.

If you have any questions regarding the billing process, please don’t hesitate to contact the City of Pullman Ambulance Department at (509) 332-8172.
 
 
Bureau of Fire Prevention Forms
icon Fire Safety Report Information and areas of observance during fire safety meetings with area businesses.
iconConstruction Permit Application Print a copy of this form, complete it, and return it to the Bureau of Fire Prevention.
iconOperational Fees Permit Application Print a copy of this form, complete it, and return it to the Bureau of Fire Prevention.
 
 
Medical/Physical Forms
icon Medical Clearance Form Updated
icon WFI Annual Physical Components Firefighter annual physical components.
icon CPT Codes Procedure codes for firefighter wellness exams.
icon Reserve FF Medical Physical Form Medical exam documentation for reserve firefighters.
icon Reserve FF Injury Form State Board for Volunteer Firefighters and Reserve Officers letter to reserve firefighters who have been injured.
icon Employee and Superviors Accident and Injury Form The information contained in this form is used to complete the most recent OSHA 300 Log, a federally mandated listing of work-related injury/accidents and/or illnesses. This form is to be signed by the employee, and it is to be reviewed by the employee’s supervisor. The supervisor shall submit the completed form to the Safety Officer (Human Resources Manager) or Deputy City Clerk within 24 hours of the work-related injury/accident or onset of work-related illness.
icon Doctor's Release for Work Doctor's release for work include all the limitations (if any) for an employee's return to work.
 
 
Reserve Forms
icon Reserve Application Application to be a Reserve Firefighter with the City of Pullman.
icon CPAT Information about the physical agility test for the fire department.
 

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