Get Ak Southern Region Ems Council Code Blue (phase 22) Equipment Requests 2020-2025

This guide provides a clear and supportive approach to filling out the AK Southern Region EMS Council Code Blue (Phase 22) Equipment Requests online. Following these steps will help ensure that your application is complete and meets all necessary guidelines.

Follow the steps to successfully complete your equipment request.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by filling in your EMS agency name and contact person information. Ensure to provide the mailing and physical shipping addresses clearly.
3. Detail the equipment you are requesting by providing the model, a clear description, the unit cost per item, your agency's local match amount, and the quantity needed for each item.
4. Include shipping costs in the total cost section. Be sure to add a note of who guarantees the request.
5. Indicate the priority level for each item requested. Attach any quotes or supporting documents as required.
6. Write a detailed justification for each item. If you are requesting a patient transport vehicle, ensure to include a complete shipping plan and estimate.
7. Specify if the equipment is new or a replacement. If needed, provide a maintenance and training plan.
8. Collect necessary signatures: the EMS agency Medical Director, the EMS agency representative, and the Subregion Coordinator. Provide the printed names and dates alongside signatures.
9. Finally, review the application to ensure all required documents, signatures, and letters of support are included. Ensure that the form is complete before submission.
10. Once all information is verified, submit the completed application to your Subregion EMS Coordinator by the deadline of November 12, 2021.

Start your application today to secure essential equipment for your EMS agency.