Scene Call of the Year Award Application

Name of Department

Date of Call (DD/MM/YYYY)

Type of Department

Full Time
Combination
Volunteer

Type of Accident

Did you use the FFL Central App to request us for this call?

Yes
No
Not sure

Comments about the App

Location of Accident

Dispatch information you were given

What you found on arrival

Describe your operation at the scene

What made this rescue/ambulance call unique from others you have completed?

What did this call teach you?

Was personal protective eyewear (PPE) used?

Yes
No

List Duty Crew

List Mutual Aid departments (include law enforcement and dispatch personnel)

Name and Title of person completing this application

Phone number where we can reach you

Your Email Address

Today's Date (DD/MM/YYYY)

Chief Officer's Name

I am forwarding photos

Yes
No

Flight For Life