Va Tech Standby Report
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Virginia Tech Rescue Squad Standby Report Form Incident # Agency:
Form #
VT 000060 -----------
Incident in CI CITY CI COUNTY of: Units:
VTRS (221)
_
Inc. Location: =L.D..;;a;,;,;te;... Public Building
_
TIMES (24 Hour Format)
Residential Institution
Responding
Educational Institution
Arrive Scene
Other Specified Location
Leave Scene
Unspecified Location
Return Service
Not Applicable Unknown
Level of Care Available
Name of Organization
_
Contact Person VTRS Manhours Attendant in Charge
Cert#
--------
Signature
Other Personnel Law Officers Fire Presonnel Total Number of Patients:
Narrative
Transports:
_
Refusals:
------
_
Form #
VT 000060 -----------
Incident in CI CITY CI COUNTY of: Units:
VTRS (221)
_
Inc. Location: =L.D..;;a;,;,;te;... Public Building
_
TIMES (24 Hour Format)
Residential Institution
Responding
Educational Institution
Arrive Scene
Other Specified Location
Leave Scene
Unspecified Location
Return Service
Not Applicable Unknown
Level of Care Available
Name of Organization
_
Contact Person VTRS Manhours Attendant in Charge
Cert#
--------
Signature
Other Personnel Law Officers Fire Presonnel Total Number of Patients:
Narrative
Transports:
_
Refusals:
------
_
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