FBL Trip Ticket 3/13

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Part 1: Course Information

• Course Sponsor

• Contact person (Name & Phone #s)

• Course #s

• Instructor 1

  Select Dupree Gill Lautner Ledford Reenan Montavon J Warner M Warner Wycoff Mantz Powell Sharps Hein Taylor Herbert Rife Zoz Best Nofziger Belcher Isgett Perko Ketner Cullison Lash Wheaton Carrol Young Beckley Hull Chapman Hotchkiss

  • Dupree
  • Gill
  • Lautner
  • Ledford
  • Reenan
  • Montavon
  • J Warner
  • M Warner
  • Wycoff
  • Mantz
  • Powell
  • Sharps
  • Hein
  • Taylor
  • Herbert
  • Rife
  • Zoz
  • Best
  • Nofziger
  • Belcher
  • Isgett
  • Perko
  • Ketner
  • Cullison
  • Lash
  • Wheaton
  • Carrol
  • Young
  • Beckley
  • Hull
  • Chapman
  • Hotchkiss

• Instructor 2

  Select Dupree Gill Lautner Ledford Reenan Montavon J Warner M Warner Wycoff Mantz Powell Sharps Hein Taylor Herbert Rife Zoz Best Nofziger Belcher Isgett Perko Ketner Cullison Lash Wheaton Carrol Young Beckley Hull Chapman Hotchkiss

  • Dupree
  • Gill
  • Lautner
  • Ledford
  • Reenan
  • Montavon
  • J Warner
  • M Warner
  • Wycoff
  • Mantz
  • Powell
  • Sharps
  • Hein
  • Taylor
  • Herbert
  • Rife
  • Zoz
  • Best
  • Nofziger
  • Belcher
  • Isgett
  • Perko
  • Ketner
  • Cullison
  • Lash
  • Wheaton
  • Carrol
  • Young
  • Beckley
  • Hull
  • Chapman
  • Hotchkiss

• Course Date & Start Time

  Date

• Number of Days

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20

• Total # of Burns

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20

Part 2: Delivery Information

• Delivery Date & Time

  Date

• Location

• Delivery Person

  Select Gill Lautner Isgett Hopkins S Smith Shaw Powell Homann Doc Metzger

  • Gill
  • Lautner
  • Isgett
  • Hopkins
  • S Smith
  • Shaw
  • Powell
  • Homann
  • Doc Metzger

• Pick-up Person

  Select Gill Lautner Isgett Hopkins S Smith Shaw Powell Homann Doc Metzger

  • Gill
  • Lautner
  • Isgett
  • Hopkins
  • S Smith
  • Shaw
  • Powell
  • Homann
  • Doc Metzger

• Person Completing Parts 1 & 2

  Sign

Part 3: Pre Trip Checklist

SCBA / Facepieces / Extra Cylinder(Full)

• 4 SCBAs Cleaned & Assigned

• 4 Facepieces

• 4 Spare Bottles

• SCBA Daily Inspection Performed

• SCBA Voice Amps

• Person Completing Work (Initials)

PPE - Helmets, Gloves etc.

• Helmets / Shields / Aluminized (Cleaned & Checked)

• Student Helmets # Assigned

• Extra Shields / Gloves / Helmet Covers

• Person Completing Work (Initials)

Burn Materials and Equipment

• Flares

• Wood for Burns

• Straw for Burns

• Class A Foam / Pro-Pak (Full)

• Person Verifying Items (Initials)

Miscellaneous Supplies

• A/V Equipment

• Tool Box

• Bucket / Cleaning Supplies

• Person Verifying Items (Initials)

Truck Check

• Truck Fuel Levels

• Truck Inspection

• Person Completing Checks (Initials)

Part 4: Additional Information

• Special Info / Problems Etc.

• Delivery or Special Instructions

• Final Sign-off