Standby EMS Schedule Change Form

Your Name(Required)

Event Name(Required)

Date of Event(Required)

This field is hidden when viewing the form

Were you notified of this event change by event staff prior to the event?(Required)

Yes

Ex: You were at the Rec and received a phone call from event staff advising of schedule change/cancellation

Type of Schedule Change(Required)

Event Ran Late/Finished Early

EMT had to stay late for patient care/PCR/equipment

Relief was late

EMT had to leave early for personal reasons

Select all that apply

Extra Hours:

To make sure your schedule change is processed correctly, please add "extra hours" to your schedule in EMS Manager.
To do this, go to "My Schedule" and then hover over the date that you need to add hours to. Then click "Submit Extra Hours." You will select the correct date and time (the start time will be the time that your shift originally ended, and the end time will be when you finished with equipment, PCRs, or patient care.) Then select the schedule that is being changed (e.g. "Penberthy") and the position ("Standby EMT" or "Trainee".) Leave "Time Type" blank. You may add notes if you wish, but this form will suffice. Only submit extra hours for PCR/Equipment/Patient Care times. Please do this before submitting the form.

Note: If you were unable to complete a PCR and did not stay late to complete it, be sure to submit extra hours for the time/date that you did complete it. This does not need to be done until you complete the PCR.

Original Event Start Time(Required)

Actual Event Start Time(Required)

Original Event End Time(Required)

Actual Event End Time(Required)

EMT End Time(Required)

Time you were done with reports, equipment, etc.

AOD Notified?(Required)

Yes

Immediate AOD notification is only required if the event no shows OR in extenuating circumstances (e.g. unable to stay late, same day cancellation, etc.) If unable to contact the AOD, reach out to Assistant EMS Manager, Operations Coordinator or Assistant Operations Coordinator.

Name of Administrator Notified(Required)

First Last

Additional Information(Required)

Please describe why the event ran late/released early.

Standby EMTs - Schedule Changes