Seal of Dane County County of Dane
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Dane County Emergency Management

Forms & Links

Forms

The following forms are for use by EMS District Directors, Training Directors, or designees. Forms that can be completed and submitted online will require a password; the password may be obtained by calling the Dane County EMS office at (608) 266-4387. Otherwise, the forms will require MS Word or Adobe Acrobat.

Upon completing the MS Word and Adobe forms, print, sign, and fax to the Dane County EMS office at (608) 266-4500.

Helpful Hints: When completing MS Word electronic forms, use the tab key or arrow keys to navigate within the form. Press the space bar to 'check' a box. Call the Dane County EMS office if you need further assistance.

Make sure all proper signatures are included on the forms at the time of submission.

Adobe Acrobat:

10 Delta Auto-ALS Project Summary
 
ALS Pilot Project FINAL REPORT
 
District Sponsored Training Roster
 
Mobile Command Center (CV-1) Non-Emergency Request Form
 
Priority Medical Dispatch Feedback Form
 
Field Feedback Report
 
Member Information & Driver's License Review Form
 
Application for Service Medical Director
 
Advanced Airway CQI
 
Base Hospital/Transportation Log
(if needed in an editable format, please contact our office)
 
Auto ALS Review - EMT/AEMT
 
Auto ALS Review - Paramedic
 

MS Word:

Subcommittee Application
 
Application for Volunteer Employment (Sample)
 
First Report of Injury
 
Member Information & Driver's License Review Form
 
Member Termination
 
Quality Assurance (QA) Report
 
Quality Assurance (QA) Report (Detailed Instructions)
 
Quality Improvement (QI) Data Collection Sheet