Rescue squad quarterly incident report




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KENTUCKY DIVISION OF EMERGENCY MANAGEMENT

RESCUE SQUAD QUARTERLY INCIDENT REPORT


Name of Rescue Squad:      

State Fiscal Year:      

County:      




Kentucky Emergency Management Area:      

Check Quarter:






First Quarter

(Jul/Aug/Sep)





Second Quarter

(Oct/Nov/Dec)





Third Quarter

(Jan/Feb/Mar)





Fourth Quarter

(Apr/May/Jun)



Type of Incident

Comments

Number of Incidents

Total

Man-hours

Light Duty Rescue

     

     

     

Extrication from Vehicles

     

     

     

Water Rescue/Recovery

     

     

     

Missing Person Search

     

     

     

Low-Angle Rescue /Recovery

     

     

     

High-Angle Rescue/Recovery

     

     

     

Cave Rescue

     

     

     

SAR with SAR Dogs

     

     

     

Dive Rescue/Recovery

     

     

     

Urban Search Rescue and Recovery

     

     

     

Fire Service Assistance

     

     

     

EMS Assistance

     

     

     

Law Enforcement Assistance

     

     

     

Emergency Management Operations Asst.

     

     

     

HAZMAT

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

TOTALS FOR THE QUARTER:

     

     




Submitted by:




Date:

     

Chief Rescue Officer Signature


Submit completed report to: Local Emergency Management Director and Division of Emergency Management Area Manager.

Review and Comments:      

     

Local Emergency Management Director: Date:      






Review and Comments:      

     

Area Manager, Division of Emergency Management: Date:      






KyEM Form 420, Rev. March 2001




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