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FOR USE BY
FAUQUIER COUNTY FIRE AND RESCUE DEPARTMENTS ONLY
DFREM FORMS
Physical Packet (For use by
DFREM Employees)
Authorization for Work Substitution (Shift Swap) (For use by DFREM
Employees)
Gear Request Form (For use
by DFREM Employees)
Sick
Leave Request (For use by DFREM Employees )
Overtime Justification Form (For use by DFREM Employees)
Unsafe Building Notice to
Residents
VFRA FORMS
Request for
Nextel Programming (For use by Fauquier County volunteers and career
staff) (YOUR PHONE MUST HAVE MESSAGING
CAPABILITY)
Agency Quarterly
Quality Management Report
Ride Along Form
Hazardous Materials
Release Reporting Form (For use by Fauquier County Fire
Departments) (Form must be filled out and faxed to DFREM)
INSURANCE FORMS
(ALL FORMS SHOULD BE FAXED TO DFREM AT
540/347-6999)
Automobile Loss
Notice (For use when a fire or rescue vehicle has been damaged)
Traveler's Workers Compensation Reporting Worksheet
(For use when
fire or rescue member has been injured; submit with Provident First
Notice of Claim)
Provident First
Notice of Claim (For use when fire or rescue member has been
injured; submit with Traveler's Workers Compensation Reporting
Worksheet)
Property Loss Notice
(For use when equipment has been damaged)
General
Liability Loss Notice (For use when a non member has been injured at
a fire or rescue station)
Life Insurance and Designation of beneficiary (For use
by Fauquier County volunteers age 18 through 65 ONLY) (Form must be
mailed or delivered to DFREM; not faxed)
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