DIRECTIONS: Per the application instructions, download, complete, and upload a copy of your personnel to the “EMS Personnel Document Upload” section of the initial or renewal application.
Please print or type names in alphabetical order. Be sure that the six digit EMT certification number is accurate. Select the appropriate level. Basic, Advanced, Paramedic, or other if the individual is not MA EMS certified. Select the appropriate employment status for each (Full Time, Part Time, Paid Per Diem, On Call or Volunteer)
REMINDER: 105 CMR 170.345 requires services to maintain records that document each attendant’s current CPR certification, EMT certification, and valid motor vehicle operator’s license including when and by whom verification of original certification was completed.
| Date published: | June 21, 2024 |
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