Please complete this form in order to update your current level of training.

Today's Date:

Fire Station Affiliation:

Name:

Phone/Cell Phone No.:

Email Address:

Please check the box next to classes that you have completed:

Orientation EMT FF1 FF2 PEAF HazMat Ops Rescue Tech CPR EVOC Instructor I

Truck Ops ICS for EMS Pump Operator Fire Officer I Fire Officer II Fire Inspector I Fire Inspector II Swiftwater Rescue Tech Fire Dept. Safety Officer Adv. Cardiac Life Support

CPR Expiration Date:

EMT Expiration Date:

If you have completed other classes not listed, please enter them here:

IMPORTANT: Please fax proof of course completion(s) to Mary Baker at 301-600-2284.

Thank you for updating your certifications, and for continuing to train and volunteer with Frederick County!