Battalion:  Battalion 1    Battalion 2    Battalion 3    Battalion 4   

                    Battalion 5    Staff (No Battalion)

 Station or Division: Select Station/Division Station 1 Station 2 Station 3 Station 4 Station 6 Station 7 Station 8 Station 9 Station 11 Station 12 Station 13 Station 14 Station 15 Station 16 Station 17 Station 18 Station 19 Station 20 Station 21 Station 22 Station 23 Station 24 Station 25 Station 26 Station 27 Station 28 Station 29 Station 30 Station 31 Station 32 Station 33 Station 34 Training Division Logistics Division Fire Prevention Administration  

 Shift:    Shift 1    Shift 2    Shift 3    Not Applicable

 Date:    Time:    Your Name:   Phone Number:

 City ID or 5-Digit Dash #:   Apparatus/Equipment:

                                                                                                          (E9, Station Generator, etc.)

 Describe the problem:

 Out of Service?  Yes    No

 Is this problem causing the equipment to be out of service?  Yes    No