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Forms & Applications

Collection of downloadable Forms in PDF or Word format.
Title Code File
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.

Application Fee: $75.00 application fee (check/money order to “Ohio Treasurer of State”) required with reinstatement applications (check/money order payable to “Ohio Treasurer of State”). For EMS Continuing Education Instructor reinstatement, the application fee is $25.

Title Code File
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, Fire Safety Inspector, and/or Hazard Recognition Officer Reinstatement Application EMS 0116 PDF
Fire, Fire Safety Inspector and/or Live Fire Instructor Reinstatement Application EMS 0109 PDF | Word


Reminder: If fire OR EMS certificate reinstatement applications are submitted together, then one $75 fee covers EMS reinstatements and one $75 fee covers fire reinstatements. For example, if you submit a FFII reinstatement independently, it’s $75. A week later, if you submit your Fire Instructor reinstatement, then you will have to pay another $75. If both are submitted at the same time, it would be just one $75 fee for your fire service reinstatements.

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.

Title Code File
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 4765.01 of the Ohio Revised Code and Chapters 4765-1 to 4765-19 of the Ohio 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 Ohio 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 Ohio Administrative Code.
EMS 5917 PDF | Word
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 Ohio Revised Code and Chapters 4765-21 and 4765-24 of the Ohio Administrative Code.
EMS 5918 PDF | Word

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
Title Code File
Request for Extension of EMS Certificates EMS 0084 PDF | Word
Request for Extension of Fire Certificates EMS 0129 PDF | Word
Title Code File
Exemption Request For Continuing Education For EMS Certificates EMS 5933 PDF | Word
Exemption Request for Continuing Education for Fire Certificates EMS 1103 PDF | Word

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.

Apply for a Priority 1 Training & Equipment Grant

Title Code File
Priority One Grant Extension Request for Training   Word
Financial Hardship Application EMS 0003 PDF | Word
Training and Equipment Approved Reimbursement List EMS 0076 PDF
EMS 2-5 Grant Budget Expenditure EMS 2081 Excel
EMS 2-5 Grant Budget & Extension Request EMS 2082 Word

Priority 2-5 Research Grants

Priority 2-5 Research grant applications are available February 1 - April 1

Priority 2-5 Research RFP Opportunities

Priority 2-5 Research RFP Opportunities are available February 1 - April 1

Sample Only Forms

Title Code File
Sample Training and Equipment Grant Application Priority 1 EMS 1803 PDF
Sample Supplemental Grant Application EMS 1805 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.

Apply For, Renew, or Manage a Medical Transportation License

Applying for, renewing, and managing a medical transportation license is done through our online system. All fees must be paid via credit card or Automated Clearing House (ACH).

Inspection Forms

The following inspection forms are provided to assist you in preparing for your inspection. They are the same forms the inspector will use during the inspection.

Ambulance

Title Code File
Headquarters Facility Inspection Emergency Medical Service EMS 4014 PDF | Word
Ambulance Inspection Advanced Life Support (ALS) EMS 4016 PDF | Word
Ambulance Inspection BLS Emergency and Non-Emergency EMS 4036 PDF | Word
Ambulance Inspection BLS Non-Emergency Only EMS 4027 PDF | Word
Non-Transport Vehicle Inspection EMS 4026 PDF | Word
Satellite Facility Inspection Emergency Medical Service EMS 4015 PDF | Word
Periodic Mechanical Safety Report EMS 4039 PDF | Word

 

Ambulette

Title Code File
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
Ambulette Employee Files EMS 4044 PDF | Word
Periodic Mechanical Safety Report EMS 4039 PDF | Word

 

MoICU

Title Code File
Headquarters Facility Inspection Emergency Medical Service EMS 4014 PDF | Word
MoICU Inspection EMS 4022 PDF | Word
Mobile Intensive Care Unit – Mobile Stroke Unit Inspection EMS 4054 PDF | Word
Satellite Facility Inspection Mobile Intensive Care Service EMS 4021 PDF | Word
Non-Transport Vehicle Inspection EMS 4026 PDF | Word
Periodic Mechanical Safety Report EMS 4039 PDF | Word

 

Air Service

Title Code File
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

 

Sample Only Forms

The following forms are for reference only. The functions of each of these forms is no longer done on paper but through the MTLS Online System.

Air Medical

Title Code File
Application for Air Medical License EMS 4003 PDF
Additional Aircraft EMS 4008 PDF
Deletion of Aircraft EMS 4013 PDF
Temporary Aircraft EMS 4046 PDF
Renewal Application for Air Medical License EMS 4042 PDF

 

Violation Notification

Title Code File
Violation Notification EMS 4029 PDF

 

Complaint Form

Title Code File
Complaint Form for EMS, Fire or Medical Transportation EMS 0050 PDF | Word

 

Medical Transportation Additional Resources

Title Code File
Ambulette Employee Physician Statement Resource   PDF
Daily Vehicle Inspection Log Resource   PDF
Title Code File
Fire Charter Renewal Application EMS 0027 PDF | Word
Fire Charter Program Director Guidebook EMS 0028 PDF
Fire Charter Application EMS 0029 PDF | Word
Written Examination Proctor Manual EMS 0030 PDF
Ohio Chartered Fire Training Program Change 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

 

EMS and Fire Course and Exam Administration

Firefighter

Title Code File
Volunteer Firefighter Course Packet EMS 0309 PDF
Firefighter I Transition Course Packet EMS 0307 PDF
Firefighter I Course Packet EMS 0304 PDF
Firefighter II Transition Course Packet EMS 0308 PDF
Firefighter I & II Course Packet EMS 0303 PDF
Volunteer Firefighter Course Objectives Check-Off EMS 0114 PDF | Word
Firefighter I and II Course Objectives Check-Off EMS 0121 PDF | Word
Courage to be Safe: Sixteen Life Safety Initiatives Course

 

Hazardous Materials Awareness & Operations

Title Code File
Hazardous Materials Awareness and Operations Course Packet EMS 0205 PDF

 

Fire Safety Inspector

Title Code File
Fire Safety Inspector Course Packet EMS 0226 PDF
Fire Safety Inspector Course Objectives Check-off Packet EMS 0312 PDF | Word

 

Hazard Recognition Officer

Title Code File
Hazard Recognition Officer Course Packet EMS 0311 PDF
Hazard Recognition Officer Course Objectives Check-off Packet EMS 0312 PDF | Word

 

Emergency Vehicle Operations

Title Code File
Emergency Vehicle Operations Course Packet EMS 0210 PDF

 

Fire Instructor

Title Code File
Ohio Fire and EMS Instructor Curriculum EMS 0122 PDF
Fire Service Training Module EMS 1109 PDF
Live Fire Training Awareness Module EMS 1110 PDF

 

Fire Safety Inspector Instructor

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

 

Live Fire Instructor (LFI)

Title Code File
Live Fire Training Operations Course Information EMS 1107 PDF
Live Fire Training Operations Job Performance Requirement Check-Off Packet EMS 1112 PDF | Word

General Course Examination Documents and Policies

Title Code File
Written Examination Proctor Manual EMS 0030 PDF
Written Testing Agreement Chartered Fire Training Programs EMS 1105 PDF | Word
Request for Change to Practical Skill Sheet EMS 1264 PDF | Word

Practical Skills Evaluation Training

Title Code File
Practical Skills Evaluator Course Manual EMS 1260 PDF
Firefighter Practical Skills Evaluator Training   PowerPoint
Practical Skills Evaluator Training Program Frequently Asked Questions EMS 1108 PDF

 

Practical Skills Evaluation - Skill Sheets

Title Code File
Volunteer Firefighter Practical Skills Examination Packet EMS 0206 PDF | Word
Firefighter 1 Practical Examination Skill Sheets EMS 5919 PDF | Word
Firefighter 2 Practical Examination Skill Sheets EMS 5920 PDF | Word
Fire Safety Inspector Practical Examination Skill Sheets EMS 5921 PDF | Word
Hazard Recognition Officer Practical Examination Skills Sheets EMS 5925 PDF

CE Program Coordinator’s Guidebook — The Handbook is currently being updated. Questions regarding EMS continuing education should be directed to the Division of EMS Education Section at EMSEducation@dps.ohio.gov.

Title Code File
Initial Application for Certificate of Approval EMS 1650 Word
Certificate of Approval - Renewal Application EMS 1651 Word

 

 

Title Code File
Psychomotor Examination Manual EMR and EMT Level EMS 0119 PDF | Word
Certificate of Accreditation Renewal Application EMS 1659 PDF | Word
Certificate of Accreditation Application EMS 1652 PDF | Word
Written Testing Agreement EMS Accredited Institutions EMS 1106 PDF | Word
Request for EMS Training Offsite Location EMS 1269 PDF | Word

 

Title Code File
Ohio Approved EMS Curriculum Standards – EMS Instructor Guidance (February, 2012)   PDF
2009 National Ems Education Standards (Currently in affect)   PDF
Rescue Task Force Awareness Training Module   PowerPoint
2021 National EMS Education Standards (for reference only)   PDF

Archived EMS Curricula

The following archived curricula were used for classes that began prior to September 1, 2012. To request a copy of an archived curriculum, email EMS Education or call the Education Testing section at (800) 233-0785 or (614) 466-9447.

  • 1994 Emergency Medical Technician-Basic: National Standard Curriculum
  • 1998 Emergency Medical Technician Paramedic: National Standard Curriculum
  • Emergency Medical Technician: Basic Refresher Curriculum (October, 2003)
  • First Responder Training Program Ohio Approved Curriculum (February, 2009)
  • Ohio EMT - Intermediate Curriculum and Transitional Course (March, 2002)
  • Ohio EMT - Intermediate Refresher Curriculum (March, 2004)
  • Ohio EMT - Paramedic Refresher Curriculum (January, 2004)

EMS Instructor Initial Certification Information

Title Code File
Written Examination Proctor Manual EMS 0030 PDF
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
Title Code File
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 Update Guide   PDF