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Please Fill Out Part 1: is Yes or No Ques0ons Does your agency have wri6en policies and procedures? Does your agency have a process in place to update wri6en policies and procedures? Does your agency have a process to confirm all agency members have received training on certain wri6en policies, procedures and prac>ces? Does your agency have wri6en documenta>on that legally establishes to agency s jurisdic>onal boundaries? Does your agency have any wri6en documenta>on that outlines firefighter authority? Does your agency have any wri6en documenta>on that designates the authority of the agency director? Does your agency have any wri6en documenta>on that describes how an employee should follow lawful orders? Does your agency have wri6en job descrip>ons for each posi>on? Does your agency have any policies on how training documenta>on will be obtained and stored? Does your agency have gas detectors? Is there an Emergency Response Guide (ERG) on every unit in your agencies? Does the agency provide fire service responses to emergency situa>ons 24 hours a day in the jurisdic>on? Does your organiza>on have a map that illustrates response district(s) in your authorized jurisdic>on? Does your agency have its own internal Communica>on Center? Is your agency part of a joint Communica>on Center? Does the Communica>on Center have an established back- up power source? Is there security on the back- up power source is protect it from tampering for Communica>on Center? Is the back- up power source periodic tested to confirm its working properly for Communica>on Center? Does your agency have a Mayday Policy? Are all agency personnel and dispatchers trained annually on the Mayday policy?

Does your agency have a Personnel Accountability Report (PAR) policy? Are all agency personnel and dispatchers trained annually on the PAR policy? Does your agency have a Wellness and Fitness Policy? Does your agency have established guidelines detailing when a firefighter needs to wear respirator protec>on or SCBA? Does your agency have an official process to repor>ng firefighter injuries? Does your agency have an official process to handle a firefighter fatality? Does your agency have established guidelines requiring all of its members to wear seat belts? Has all of the uniformed members completed the Na>onal Fallen Firefighters Founda>on Courage to be Safe Program? Does your agency have established guidelines and procedures in helping keep equipment (Fire Hose, SCBA, PPE, etc ) maintained to manufacture standards? Does your agency have an established Code of Ethics? Does your agency have a wri6en Oath of Office statement for promo>ons? Does your agency have wri6en direc>ve that prohibits sexual or other unlawful harassment? Does your agency have wri6en direc>ve that prohibits the use of alcohol and illegal drugs when repor>ng to work and while on duty. Part 2: Briefly respond to the following ques0ons. Explain how your agency handles emergency medical incidents within the agency s jurisdic>on? Explain how a pa>ent needing transport to a hospital is handled by your agency? Explain how your agency manages training records?

If your agency operates an Emergency Dispatch Center, explain how dispatchers are trained on your agencies opera>ons? Explain what resources your agency u>lizes when responding to confined space rescue incidents in your jurisdic>on? responding to a confined space rescue in your jurisdic>on? List all other agencies that will respond to a confined space rescue in your jurisdic>on? List all specialized confined space rescue equipment that your agency owns? Explain what resources your agency u>lizes when responding to trench rescue incidents in your jurisdic>on? responding to a trench rescue in your jurisdic>on? List all other agencies that will respond to a trench rescue in your jurisdic>on? List all specialized trench rescue equipment that your agency owns?

Explain what resources your agency u>lizes when responding to hazard materials incidents in your jurisdic>on? responding to a hazard materials in your jurisdic>on? List all other agencies that will respond to a hazmat materials incident in your jurisdic>on? List all hazmat materials equipment that your agency owns? How does the agency ensure that pa>ent privacy is maintain on all medical records? How does the agency maintain record security to prevent unauthorized access? List the security and privacy training agency members are providing on agency records? When does the agency report firefighter injuries to the Texas Commission on Fire Protec>on? When does the agency provide data to the Texas Fire Incident Repor>ng System (TxFIRS)? How o\en does your agency inspect SCBA s, apparatuses, and assigned equipment?

Where are the completed inspec>on forms kept? Who inves>gates fires in the agency s jurisdic>on? What agency policies cover fire cause determina>on? Explain your agency s Public Safety Educa>on program(s)? What is the agency s established performance objec>ves for turn- out >mes? Explain the response matrix for the number of firefighters and apparatuses that will ini>ally respond to the report of a structure fires in the agency s jurisdic>on? Explain the response matrix for the number of firefighters and apparatuses that will respond to the different types of emergency medical calls in the agency s jurisdic>on?