EXTRICATION EQUIPMENT EXEMPTION
In accordance with Department of Public Health Rules and Regulations
290-5-30-.05(6)(f), ___________________________________ Ambulances Service does
request an exemption from carrying the following equipment by virtue of the fact that the
equipment is immediately available from ______________________________________
in ________________ county.
1 spring loaded center punch
1 rescue ax or halogen tool
1 6-inch or 8-inch flathead screwdriver
1 three-pound hammer
1 hacksaw with 2 extra blades
1 roll duct tape
1 one-ton come-a-long and two rescue chains or straps
1 pair “safety” goggles or helmet with shield or equivalent eye protection
1 pair gloves, work gloves or leather gloves
____________________________________________
Chief of Rescue/Fire Service
________________________
Date
____________________________________________
EMS Director
________________________
Date