KCTCS2013-2014 Fire Dept. Training Request

KCTCS2013-2014 Fire Dept. Training Request

State Fire/Rescue Training Area 5 Please return by September 30, 2013

Indicate up to 30 hours of single instructortraining from the courses listed below.

BASIC FIRE SUBJECTS# hours

A0000____Administration & Org_____

B0000____Safety_____

C0000____Fire Alarm & Communications_____

D0000____Fire Behavior_____

E0000____Extinguishers_____

F0000____Personal Protective Equipment_____

G0000____Forcible Entry_____

H0000____Ventilation_____

I0000 ____Ropes_____

J0000____Ladders_____

K0000____Fire Hose/Nozzles/Appliances_____

L0000 ____Foam Fire Streams_____

M0000____Fire Control_____

N0000____Salvage_____

O0000____Overhaul_____

R0000____Water Supply_____

S0000____ Sprinklers Training_____

U0000____Fire Prevention/Public Fire Ed_____

V0000____Building Construction_____

W0000____Aircraft Crash Firefighting_____

X0000____Emergency Disaster Planning_____

Y0000____ Fire Investigation Training_____

EE0000 ____ Building Pre-Planning Training_____

APPARATUS

R0000____ Mobile Water Supply_____

Z0000 ____ Pump Ops & Maint (Gen/Update)_____

Z0000 ____ Pump Ops & Maint (Full Course)_16__

Z0000____ How to Test Pumps_____

CC0000____Drivers Training (General/Update)_____

CC0001____ Drivers Training (Full Course)_12__

CC0002____ Drivers Training (POV)_____

CC0000____ Trailer Ops/Safety (Classroom)__4__

CC0000____ Trailer Ops/Safety (Cone Course)__4__

HH0000____ Aerial Operations (Gen/Update) _____

HH0001____ Aerial Operations (Full Course) _20__

EMERGENCY MEDICAL TRAINING

P0000____ First Aid_____

P0001____ CPR/AED Training_____

P0002____ BBP/HIV/AIDS Training_____

_____Cont. Ed Hours (Specify Level & Topics)_____

______

HIGHWAY/TRAFFIC SAFETY # hours

B0000 ____ Emergency Traffic Control _4__

B0000 ____ Highway Crash Site Mgmt. _4__

RESCUE # hours

Q0000____ Rescue (Specify Topic)____

Q0001____ High Pressure Airbags_2__

Q0001____ Hybrid Vehicle Incidents_4__

Q0001____ Occupant Protection Sys_4__

Q0001 ____ Vehicle Rescue/Extrication ____

Q0006 ____ Farm Rescue Awareness _4__

FIRE OFFICERS TRAINING#hours

AA0000 ____ Leadership I_14__

AA0000 ____ Leadership II_14__

AA0000 ____ Leadership III_14__

AA0000 ____ MCTO-D_16__

AA0000 ____ STICO_16__

AA0000 ____ PICO_16__

AA0000 ____ Incident Safety Officer_16__

AA0000 ____ Officers Training (Specify Hours, Level, and Topics)_____

______

HAZARDOUS MATERIALS

T0000 ____ Hazmat (Specify Topics)_____

T0001 ____ Emergency Response Guide__4__

T0001 ____ Hazmat Awareness__8__

T0002 ____ Hazmat Operations_16__

T0004 ____ Refresher (Specify Level)_____

NIMS

FF0001 ____ ICS 100__4__

FF0002 ____ ICS 200__4__

FF0007 ____ ICS 700__4__

FF0008 ____ ICS 800__4__

OTHER AVAILABLE COURSES

B0000 ____ Utility Emergencies__3__

B0000 ____ VIPER - Violence Intervention

by Prevention for Emer. Responders__2__

X0000 ____ Terrorism/WMD Awareness__3__

X0000 ____ Weather Emergencies__3__

BB0000 ____ Methodology Refresher__8__

FC0003 ____ Wildland Fire Awareness__4__

B0000 ____ Courage to Be Safe__4__

Additional Courses Requested by County or Multiple Departments

Certain classes, such as Firefighter Survival and Rescue, ICS 300/400, Hazardous Materials Technician, IFSAC Fire Officer I, and several others may be available on a countywide basis or by multiple departments collectively pooling their hours. If you are interested in one of these classes or a class that you don’t see listed on this form, email: o inquire for more information.

DEPARTMENT CONTACT INFORMATION (Please complete all blanks)

Fire Department Name ______

Physical address of primary station:

______

Street AddressCityZip Code

Mailing address of primary station:

______

Street AddressCityZip Code

Fire Department Phone Number ______

Fire Department General Email Address ______

Fire Department Website ______

Fire Chief’s Name ______

Fire Chief’s Phone Number(s)

Fire Chief’s E-mail Address ______

Training Officer’s Name ______

Training Officer’s Phone Number(s)

Training Officer’s Email Address ______

Which should our instructors contact first to schedule the classes, the Fire Chief or Training Officer? ______

Month you would like training to begin?

Fire Chief’s Signature

Return this form to: State Fire/Rescue Training Area 5, 630 College St Road, Elizabethtown, KY42701

Visit our website for upcoming training opportunities.

Revised 6/20/13