"Fire and Emergency Medical Services Study Self-assessment Questionnaire" - Virginia

Fire and Emergency Medical Services Study Self-assessment Questionnaire is a legal document that was released by the Virginia Department of Fire Programs - a government authority operating within Virginia.

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IRE AND
MERGENCY
EDICAL
ERVICES
TUDY
ELF
SSESSMENT
UESTIONNAIRE
Name:
Title:
Locality Name:
1.
This request is being made by:
□ Local Fire Department
□ Other Fire Services Organization
□ Local Government
□ Other: (Please specify)
2.
Scope of Study: Study results/recommendations will be comprehensive in nature. Below
areas will be evaluated. Please add additional areas the locality wants assessed.
a. Organization
b. Budget and Central Purchasing
c. Personnel
d. Training
e. Fleet Design and Management (Equipment/Apparatus)
f. Operations:
g. Other: (Please specify below)
3.
Can you provide a current organizational chart? If yes, please email it to
policyoffice@vdfp.virginia.gov.
□ Yes □ No
4.
What best describes your fire operations response?
□ Career
□ Volunteer
□ Combination (both career and volunteer)
5.
What best describes your EMS operations response?
□ Career
□ Volunteer
□ Combination (both career and volunteer)
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Q
IRE AND
MERGENCY
EDICAL
ERVICES
TUDY
ELF
SSESSMENT
UESTIONNAIRE
Name:
Title:
Locality Name:
1.
This request is being made by:
□ Local Fire Department
□ Other Fire Services Organization
□ Local Government
□ Other: (Please specify)
2.
Scope of Study: Study results/recommendations will be comprehensive in nature. Below
areas will be evaluated. Please add additional areas the locality wants assessed.
a. Organization
b. Budget and Central Purchasing
c. Personnel
d. Training
e. Fleet Design and Management (Equipment/Apparatus)
f. Operations:
g. Other: (Please specify below)
3.
Can you provide a current organizational chart? If yes, please email it to
policyoffice@vdfp.virginia.gov.
□ Yes □ No
4.
What best describes your fire operations response?
□ Career
□ Volunteer
□ Combination (both career and volunteer)
5.
What best describes your EMS operations response?
□ Career
□ Volunteer
□ Combination (both career and volunteer)
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IRE AND
MERGENCY
EDICAL
ERVICES
TUDY
ELF
SSESSMENT
UESTIONNAIRE
O
E
RGANIZATION
STABLISHMENT
6.
Is your organization (Fire or EMS agencies/departments) established by local or county
government?
□ Yes
□ No
□ Other
7.
Are all of the organizations (Fire or EMS agencies/departments) participating in this
study established by a local government or county government ordinance? If yes, please
email those to policyoffice@vdfp.virginia.gov.
□ Yes
□ No
□ Other
8.
Does the local government’s establishing ordinance clearly authorize all services that are
provided by your organization (Fire or EMS agencies/departments)?
□ Yes
□ No
9.
Does your organization have stated short and long term goals?
□ Yes, but Fire Only
□ Yes, but EMS Only
□ Yes, both Fire and EMS
□ No
C
A
ENTRALIZED
UTHORITY
10. Do you operate under a centralized Fire and EMS authority?
□ Yes
□ No
11. If yes to the above, what is the title of the position that oversees the central Fire and
EMS organization?
12. Is there an organization (i.e. Fire and Rescue Association) or similar body that discusses
Fire and EMS issues collaboratively?
□ Yes
□ No
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IRE AND
MERGENCY
EDICAL
ERVICES
TUDY
ELF
SSESSMENT
UESTIONNAIRE
F
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UNDING AND
ESOURCES
13. Does the local government provide funding?
□ Fire
□ EMS
□ No funding provided
14. Does your organization charge for services?
□ Fire Services
□ EMS Services
□ We do not charge
15. Does the jurisdiction/local government own the:
□ Fire Apparatus
□ EMS Vehicles
□ Stations
16. Does your jurisdiction/locality have a:
□ Fire Marshal
□ Public Fire and Life Safety Educator
□ Fire Corps Program
17. Does your jurisdiction/locality have a:
□ A Coordinated Centralized Training Program for Fire
□ A Coordinated Centralized Training Program for EMS
□ A Fire Training Officer
□ An EMS Training Officer
S
TANDARDIZATION
18. Has your jurisdiction/locality adopted the Statewide Fire Prevention Code?
□ Yes
□ No
19. Does your jurisdiction/locality provide public fire and life safety activities?
□ Yes
□ No
20. Does your jurisdiction/locality have formal written Mutual or Automatic Aid agreements
with your neighboring jurisdictions/localities?
□ Fire
□ EMS
□ We do not have formal written agreements
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EDICAL
ERVICES
TUDY
ELF
SSESSMENT
UESTIONNAIRE
21. Does your jurisdiction/locality have current, written Standard Operating Procedures
(SOPs) and/or Standard Operating Guidelines (SOGs) that all organizations follow? If
yes, please email those to policyoffice@vdfp.virginia.gov.
□ Fire
□ EMS
□ We do not have SOPs and/or SOGs
22. Does your jurisdiction/locality have established written response time criteria?
□ Fire
□ EMS
□ We do not have written response time criteria
23. Does your jurisdiction/locality have centralized and structured dispatch criteria with
predetermined response criteria?
□ Fire
□ EMS
□ We do not have centralized and structured dispatch criteria
24. Does your dispatch center practice Emergency Medical Dispatch (EMD)?
□ Yes
□ No
25. Is your jurisdiction/locality NIMS compliant?
□ Yes
□ No
26. Does your jurisdiction/locality have a written policy for minimum staffing level for:
□ Fire
□ EMS
□ We do not have a written policy for minimum staffing levels
27. Does your jurisdiction/locality have a structured Recruitment and Retention program?
□ Career Fire
□ Volunteer Fire
□ Career EMS
□ Volunteer EMS
□ We do not have program
28. Does your jurisdiction/locality have minimum standardized training requirement?
□ Yes
□ No
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IRE AND
MERGENCY
EDICAL
ERVICES
TUDY
ELF
SSESSMENT
UESTIONNAIRE
29. Does your jurisdiction/locality have a centralized data collection system?
□ Fire - VFIRS
□ EMS - PPDR
□ EMS - VPHIB
POPULATION AND STUDY
30. What is the daytime population of the area being served?
31. What is the nighttime population of the area being served?
32. Have you had a similar study conducted within the past five years?
□ Fire
□ EMS
□ Other
33. What prompted your request for this study? Please provide detailed comments below.
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