Forms & Applications

Initial Instructor Certification

EMS Instructor Initial Application EMS 0086 PDF Word
Assistant EMS Instructor Initial Application EMS 5902 PDF Word
EMS Continuing Education Instructor Initial Application EMS 0089 PDF Word
Physician EMS Instructor Initial Application EMS 0052 PDF Word
Physician Continuing Education Instructor Initial Application EMS 0052 PDF Word
Fire, Assistant Fire and/or Fire Safety Inspector Instructor Initial Application EMS 0107 PDF

Live Fire Instructor

Certification requirements vary depending on when an individual was certified as a Fire Instructor or Assistant Fire Instructor. If you received your Fire Instructor or Assistant Fire Instructor certification prior to January 1, 2018 you may be eligible for a full or partial exemption (“grandfathering”) from completing the Live Fire Instructor certification requirements.

Click HERE for additional information on the Live Fire Instructor Certification, including course entrance requirements, certificate qualifications, and exemption ("grandfathering") options.

NOTE: If ineligible for the exemption (“grandfathering”), the Live Fire Instructor application will be made available upon completion of course and job performance certification requirements.

 

Reinstatement Applications

EMS Application - Reinstatement EMS 0088 PDF Word
EMS Instructor Reinstatement Application EMS 5922 PDF Word
Assistant EMS Instructor Reinstatement Application EMS 5923 PDF Word
EMS Continuing Education Instructor Reinstatement Application EMS 5924 PDF Word
Firefighter and Fire Safety Inspector Reinstatement Application EMS 0116 PDF
Fire, Fire Safety Inspector and/or Live Fire Instructor Reinstatement Application EMS 0109 PDF Word

 

Reciprocity Packets & Applications

Application Fee: $75.00 application fee required with EMS provider reciprocity applications (check/money order payable to “Ohio Treasurer of State”). There are no reciprocity application fees for firefighter or fire instructor.

EMS Provider (EMR, EMT, AEMT, Paramedic)
For purposes of granting reciprocity, the State Board of Emergency Medical, Fire, and Transportation Services may review EMS license or certification requirements in other states, the district of Columbia, or the U.S. military to identify those that are substantially similar to the curriculum and certification standards set forth in Chapter 4765. of the Revised Code and Chapters 4765-1 to 4765-19 of the Administrative Code.
EMS 5911 PDF Word
EMS Instructor
For purposes of granting reciprocity, the State Board of Emergency Medical, Fire, and Transportation Services may grant an individual who has completed a course of instruction in teaching methodology in another state, the district of Columbia, a United States territory, as a member of the armed forces of the United States military, the Ohio national guard, the Ohio military reserve, the Ohio naval militia, the national guard of any other state or a reserve component of the armed forces of the United States, or the United States coast guard, a certificate to teach as an EMS instructor, if the applicant meets all of the requirements set forth in 4765-18 of the Administrative Code.
EMS 1647 PDF Word
Firefighter (Volunteer, FFI, FFII)
For purposes of granting reciprocity, the executive director may review firefighter licensing or certification requirements and firefighter training standards from another state, the District of Columbia, a United States territory, any branch of the United States military, or other firefighter training program approved by the Division of EMS executive director to identify those requirements and standards that are substantially similar to the curriculum and certification standards as set forth in Chapters 4765-20 and 4765-24 of the Administrative Code.
EMS 5917 PDF
Fire Instructor
For purposes of granting reciprocity, the executive director may review firefighter instructor licensing or certification requirements and firefighter instructor training standards from another state, the District of Columbia, a United States territory, any branch of the United States military, or, other fire instructor training program approved by the executive director, to identify those requirements and standards that are substantially similar to the curriculum and certification standards set forth in section 4765.55 of the Revised Code and Chapters 4765-21 and 4765-24 of the Administrative Code.
EMS 5918 PDF

Certifications not eligible for certification via reciprocity per the Ohio Administrative Code:

  • Fire Safety Inspector
  • Hazard Recognition Officer
  • Assistant EMS Instructor
  • Assistant Fire Instructor
  • Live Fire Instructor

 

Request for Extension

Request for Extension of EMS Certificates EMS 0084 PDF Word
Request for Extension of Fire Certificates EMS 0129 PDF Word

 

Request for Exemption

Exemption Request For Continuing Education For EMS Certificates EMS 5933 PDF Word
Exemption Request for Continuing Education for Fire Certificates EMS 1103 PDF Word

 

Grant Applications & Forms

Priority 1 Training & Equipment Grant

Priority 1 applicants shall apply online. Instructions to create an account may be found in our user guide. For assistance logging on to the grants application website, please email our help desk, or call 614-752-6487.

The grant application period is closed. The application process for the next grant cycle will begin on February 1 and remain open for application submissions until April 1 at 5:00 p.m.

 

Priority One Grant Extension Request for Training Word
Financial Hardship Application EMS 0003 PDF Word
Training and Equipment Approved Reimbursement List EMS 0076 PDF Word

Priority 2-5 Research Grants

Research Grant Application Priority 2-5 (EMS grant applications are available February 1 - April 1) EMS 2083 PDF Word

Sample Only Forms

Sample Training and Equipment Grant Application Priority 1 EMS 1803 PDF
Sample Research Grant Application Priority 2-5 EMS 2083 PDF

Please email the Grants Section if you have any questions about grant application forms.

 

Medical Transportation Checklists & Forms

Ambulance

License Application Checklist EMS 4028 PDF Word
Application for Ambulance or Mobile Intensive Care License EMS 4001 PDF Word
Headquarters Facility Inspection Emergency Medical Service EMS 4014 PDF Word
Ambulance Inspection EMS 4016 PDF Word
Satellite Facility Inspection Emergency Medical Service EMS 4015 PDF Word
Additional Ambulance / MOICU / Non-Transport Vehicle EMS 4006 PDF Word
Deletion of Ambulance EMS 4012 PDF Word
Non-transport Vehicle Inspection EMS 4026 PDF Word
Headquarters Change of Address EMS 4004 PDF Word
Application for New Satellite EMS 4005 PDF Word
Temporary Ambulance / MoICU / Non-Transport Vehicle EMS 4009 PDF Word
Change in Level of Service Medical Transportation Organization EMS 4011 PDF Word
Periodic Mechanical Safety Report EMS 4039 PDF Word

Ambulette

License Application Checklist EMS 4028 PDF Word
Application for Ambulette License EMS 4002 PDF Word
Headquarters Facility Inspection Non-Emergency Medical Service EMS 4017 PDF Word
Ambulette Inspection EMS 4019 PDF Word
Satellite Facility Inspection Non-Emergency Medical Service EMS 4018 PDF Word
Additional Ambulette EMS 4007 PDF Word
Deletion of Ambulette EMS 4012 PDF Word
Headquarters Change of Address EMS 4004 PDF Word
Application for New Satellite EMS 4005 PDF Word
Temporary Ambulette Application EMS 4010 PDF Word
Ambulette Employee Files EMS 4044 PDF Word
Periodic Mechanical Safety Report EMS 4039 PDF Word

MoICU

License Application Checklist EMS 4028 PDF Word
Application for Ambulance or Mobile Intensive Care License EMS 4001 PDF Word
Headquarters Facility Inspection Mobile Intensive Care Service EMS 4020 PDF Word
MoICU Inspection EMS 4022 PDF Word
Satellite Facility Inspection Mobile Intensive Care Service EMS 4021 PDF Word
Additional MoICU / Non Transport Vehicle EMS 4006 PDF Word
Deletion of MoICU EMS 4012 PDF Word
Non-Transport Vehicle Inspection EMS 4026 PDF Word
Headquarters Change of Address EMS 4004 PDF Word
Application for New Satellite EMS 4005 PDF Word
Temporary Ambulance / MOICU / Non-Transport Vehicle EMS 4009 PDF Word
Change in Level of Service Medical Transportation Organization EMS 4011 PDF Word
Periodic Mechanical Safety Report EMS 4039 PDF Word

Air Service

License Application Checklist EMS 4028 PDF Word
Application for Air Medical License EMS 4003 PDF Word
Headquarters Facility Inspection Air Medical Service EMS 4023 PDF Word
Aircraft Inspection EMS 4025 PDF Word
Satellite Facility Inspection Air Medical Service EMS 4024 PDF Word
Additional Aircraft EMS 4008 PDF Word
Deletion of Aircraft EMS 4013 PDF Word
Headquarters Change of Address EMS 4004 PDF Word
Application for New Satellite EMS 4005 PDF Word

Sample Only Forms

Renewal Application for Ambulance or Mobile Intensive Care EMS 4040 PDF
Renewal Application for Ambulette License EMS 4041 PDF
Renewal Application for Air Medical License EMS 4042 PDF
Violation Notification EMS 4029 PDF

Miscellaneous 

Complaint Form for EMS, Fire or Medical Transportation EMS 0050 PDF Word

 

Fire Charter Program Administration

Fire Charter Program Director Guidebook EMS 0028 PDF
Fire Charter Application EMS 0029 PDF Word
Change of Fire Program Notification EMS 0083 PDF Word
Request for Fire Training Offsite Location EMS 1270 PDF Word
Written Testing Agreement Chartered Fire Training Programs EMS 1105 PDF Word
Request for Change to Practical Skill Sheet EMS 1264 PDF Word
ADA Policy   PDF

 

Fire Charter Course Materials

Firefighter

Volunteer Firefighter Certification Requirements (General Course Info., Course Requirements & Course Objectives) EMS 0209 PDF
Firefighter I Transition Certification Requirements (General Course Info., Course Requirements & Course Objectives) EMS 0207 PDF
Firefighter I Certification Requirements (General Course Info., Course Requirements & Course Objectives) EMS 0204 PDF
Firefighter II Transition Certification Requirements (General Course Info., Course Requirements & Course Objectives) EMS 0208 PDF
Firefighter I & II Certification Requirements (General Course Info., Course Requirements & Course Objectives) EMS 0203 PDF
Volunteer Firefighter Course Objectives Check-Off Packet EMS 0114 PDF Word
Firefighter I and II Course Objectives Check-Off Packet EMS 0121 PDF Word
Courage to be Safe: Sixteen Life Safety Initiatives Course    

Hazardous Materials Awareness & Operations

Hazardous Materials Awareness and Operations Course Objectives (General Course Info., Course Requirements & Course Objectives) EMS 0205 PDF

Fire Safety Inspector

Fire Safety Inspector Course Objectives (Course Packet)–DRAFT EMS 0126 PDF

Hazard Recognition Officer

Hazard Recognition Officer Certification Requirements (Course Packet)–DRAFT EMS 0211 PDF

Emergency Vehicle Operations

Hazard Recognition Officer Certification Requirements (Course Packet)–DRAFT EMS 0210 PDF

Fire Instructor

Ohio Fire and EMS Instructor Curriculum EMS 0122 PDF
Fire Service Training Module EMS 1109 PDF
Live Fire Training Awareness Module EMS 1109 PDF

Fire Safety Inspector Instructor

Ohio Fire and EMS Instructor Curriculum EMS 0122 PDF
Fire Safety Inspector Training Module EMS 0202 PDF

Live Fire Instructor (LFI)

Live Fire Training Operations Course (Course Packet) EMS 1107 PDF
Live Fire Training Operations Course Instructor Guide – Contact the Division of EMS    
Live Fire Training Operations Course Student Guide – Contact the Division of EMS    
Live Fire Training Operations Course PPT Slides – Contact the Division of EMS    
Live Fire Training Operations Job Performance (JPR) Check-Off EMS 1112 PDF Word

 

Fire Charter Course Examinations

General Course Examination Documents and Policies

Course and Examination Administration Manual EMS 1271 PDF
Written Testing Agreement Chartered Fire Training Programs EMS 1105 PDF Word
Request for Change to Practical Skill Sheet EMS 1264 PDF Word
ADA Policy   PDF

Practical Skills Evaluation Training

Practical Skills Evaluator Training Course Manual EMS 1260 PDF
Firefighter Practical Skills Evaluator Training (Training program being revised; currently unavailable)  
Practical Skills Evaluator Training Program Frequently Asked Questions EMS 1108 PDF

Practical Skills Evaluation – Skill Sheets

Volunteer Firefighter Practical Skill Sheets (Packet) EMS 0206 PDF
Firefighter I and Firefighter II Practical Skill Sheets (Packet) EMS 1243 PDF
Firefighter I and Firefighter II Practical Skills Evaluation – Individual Forms    
Hazard Recognition Officer Practical Skill Sheets (Packet – Currently under development)    
Fire Safety Inspector Practical Skill Sheets (Packet – Currently being revised to accommodate new fire code)    

Practical Skills Test Summary

Volunteer Firefighter Course Practical Skill Test Summary

EMS 0130 PDF Word
Firefighter I Course Practical Skill Test Summary EMS 1262 PDF Word
Firefighter I and II Course Practical Skill Test Summary EMS 1261 PDF Word
Firefighter II Course Practical Skill Test Summary EMS 1263 PDF Word

 

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EMS Training Program Administration

Certificate of Accreditation Application EMS 1652 PDF Word
Written Testing Agreement EMS Accredited Institutions EMS 1106 PDF Word

 

EMS Training Program Curriculum & Education Standards

Ohio Approved EMS Curriculum Standards – EMS Instructor Guidance   PDF
National EMS Education Standards   PDF

 

EMS Training Program Instructor Information

EMS Instructor

EMS Assistant Instructor

EMS Physician Instructor

Ohio Fire and EMS Instructor Curriculum EMS 0122 PDF
Ohio EMS Instructor Curriculum Mentorship Program for Assistant EMS Instructors EMS 0128 PDF
EMS Instructor Orientation   PDF

 

More Forms

Request for Replacement Card EMS 0079 PDF Word
Change of Address EMS 0080 PDF Word
Declaration of Criminal History EMS Certificates EMS 0095 PDF Word
Declaration of Criminal History Fire Certificates EMS 0101 PDF Word
Complaint Form for EMS, Fire, or Medical Transportation EMS 0050 PDF Word
Application Fee / Disciplinary Payment Remittance EMS 1101 PDF Word
Regional Physician Advisory Board Membership Application EMS 0096 PDF Word
EMS / FIRE Agency Information EMS 0018 PDF Word

 

Have Questions?

Email us at Ask EMS

Or call (614) 466-9447 or (800) 233-0785

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