Willard Fire Department
Pride     Perfection     Professionalism

EMS Forms

Fire Forms
Form 1008 - Notice of Privacy Practices (HIPAA Form)
File Size: 563 kb
File Type: pdf
Download File
Form 1010 - Patient Request for Access to Protected Health Information (PHI)
File Size: 636 kb
File Type: pdf
Download File
Form 1012 - Patient Request for Amendment of Protected Health Information (PHI)
File Size: 564 kb
File Type: pdf
Download File
Form 1103 Physician Certification Statement & Form 1105 Attestation PCS Signature
File Size: 308 kb
File Type: pdf
Download File
DNR Do Not Resuscitate Form
File Size: 22 kb
File Type: pdf
Download File
Forms can be sent to Willard Fire & Rescue's Compliance Officer via:
Email:    JWeiss@WillardOhio.us
Fax:        (419) 933-7800
Mail:      Willard Fire & Rescue
                  425 Fort Ball Rd, PO Box 367
                  Willard, OH  44890

​Still Have Questions?  Contact the Compliance Officer
Email:    JWeiss@WillardOhio.us
Phone:  (419) 935-8287
                  Ext# 1343  (Compliance Officer)
                  Ext# 0           (Station for General Questions)

Student & Observer Forms

Student & Observer Forms 2020
File Size: 651 kb
File Type: pdf
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Know Ohio's Open Burning Regulations (ver May 2020)
File Size: 3082 kb
File Type: pdf
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What You Can Burn in the Neighborhood (English)
File Size: 197 kb
File Type: pdf
Download File
What You Can Burn in the Neighborhood (Spanish)
File Size: 372 kb
File Type: pdf
Download File
Open Burn Permission Request Form (ver 1.2 04/2018)
File Size: 169 kb
File Type: pdf
Download File
Open Burn Notification Form (ver 1.2 04/2018)
File Size: 155 kb
File Type: pdf
Download File
Open Burn Notification Form Horticultural (ver 1.0 04/2018)
File Size: 142 kb
File Type: pdf
Download File

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