Chicago Fire Department Ride Form – Fill Out and Use This PDF

CHICAGO FIRE DEPARTMENT

Bureau of Operations

Division of Training

The Chicago Fire Department has established the following criteria for application to the Officer Development Program and for participation in the Ambulance Ride-Along Program. Both programs provide individuals with the opportunity to observe Chicago Fire Department (CFD) field operations and to become familiar with the functionality and utilization of the department’s apparatus. A description of the ambulance ride-along program, program prerequisites and requirements, and the application process are outlined below. Civilian participation in either program will only be allowed by permission of the Fire Commissioner.

Ambulance Ride-along Program

As of January 1, 2011 the ride along program is limited to:

Physicians and nurses affiliated with Region XI Hospitals.

EMT-B and EMT-P students from the City Colleges of Chicago.

EMT-B’s and EMT-P’s from the Chicago Police Department and the Chicago Office of the Federal Bureau of Investigation.

Medical Students from Rush University, University of Chicago and the University of Illinois medical schools.

Off duty members of the Chicago Fire Department enrolled in EMT-B and EMT-P programs.

Office of Emergency Management and Communications (OEMC) staff.

NOTE:

Ambulances 14, 15, 49 and 55 are reserved ambulances and have limited availability.

Paramedic students at Malcolm X College ride with assigned preceptors. Those ambulances are not available to others during their scheduled ride period.

All riders must complete a current waiver of liability form and submit a copy of a State Issued I.D. (driver’s license or ID card).

Riders must be off ambulances by 2200 hours, with the exception of the paramedic students from Malcolm X College and CFD members enrolled in EMT-B and EMT-P courses who are riding for 16 hours).

Ambulances will NOT be reserved until a waiver is received, (except for on duty OEMC and CPD members). Waivers are valid for one year from the date received.

Only physicians and nurses are allowed to ride on BLS ambulances.

Two (2) weeks prior notice is required for processing. (limited exceptions).

APPLICATIONS AND WAIVERS SHOULD BE FAXED TO EMS TRAINING OFFICE AT: (312) 746-6541

CHICAGO FIRE DEPARTMENT

Bureau of Operations

Division of Training

Ambulance Ride-along Application

EMT Student	____	RN / ECRN	____
EMT-B / EMT-P	____	Physician	____
Name: _______________________________		Telephone# __________________________

email: _______________________________________________________________________

Address: _____________________________________________________________________

City: ________________________________ State: _____ Zip Code: ______________

Circle institution affiliation or enter here if not listed: _______________________________

U of C	MXC	CFD	NWMH	CPD	IMMC
Wright	Rush	Christ	FBI	Stroger	University of
college	University	Hospital		Hospital	Illinois
Provident	Olive-Harvey	Resurrection	Truman	CFD/South	Mt. Sinai
Hospital	College	Hospital	College	Suburban	Hospital
EMERGENCY CONTACT INFORMATION:
Name: _______________________________			Telephone# __________________________

Address: ____________________________________________________________________

City: ________________________________ State: _____ Zip Code: ______________

Relationship: ________________________________________________________________

REQUESTED DATE: __________________ REQUESTED AMBULANCE: __________

This form MUST be submitted at least 2 weeks prior to the requested date

Fax to: (312) 746-6540

For office use only

Approved:	Date: ________________________ __
	Ride Date: ______________________
Peter Van Dorpe
District Chief	Ride Ambulance: ________________
Division of Training