IQS DATA COLLECTION/DATA ENTRY FORM

"*" Denotes a mandatory field

1. PERSON/ORG INFORMATION

Person Id
Last Name *
First Name *
Job Title *
 Employment Status *
 
Station Address
City, State, Zip
Home Address *
City, State, Zip *
E-mail Address *
 
Cell # * format (999) 999-9999
Home # * format (999) 999-9999
Pager # * format (999) 999-9999
Work # * format (999) 999-9999
Work2 # format (999) 999-9999
Emergency Contact Info --(Station phone#) *

2.FITNESS LEVEL *

 Fire Chief/Certifier * Effective date(omit or N) *

3. TARGET POSITIONS

Target Position
Risk
Date Created

4. TASK BOOKS IN PROGRESS

Qual
Risk
Date Issued/Initiated
Issuer
Date Completed

 

5.TRAINING AND PLANNED TRAINING

Course
Risk
Complete Date

6. QUALIFICATION NOTE:

For the Experience portion of IQS to function properly, list all positions an employee is qualified for positions with no Position
Priority will not print on the incident card - maximum of 7 print.

Type(JOB,TRN, SKILL)
Qual
Risk
Effective Date
Fire Chief/ Certifier

7. EXPERIENCE

Type(JOB, TRN, OJT)
Qual
Risk
Incident#
Experience Date