KITSAP ONBOARDING FORM

KITSAP ONBOARDING FORMTamarah Hoffman2023-03-17T15:00:21-07:00

All incoming Kitsap providers should provide the following form and supporting documents to the KCEMS office. Please contact [email protected] or at 360.447.2068 to ensure the form has arrived.

Once the form has been received by the KCEMS office, the provider will receive notice of their core training enrollments.

First name *

Email address *

Last name *

Phone number *

Do you already have an Vector Account?

Yes, Please link my accounts together.

No.

Other Target Account Agency

What is your level of certification?

Paramedic

EMT

Will your primary district will be in Kitsap?

hint: You will do your OTEP training here.

Yes- Primary in Kitsap

No- I am primary in another district. (nonprimary)

What will be your primary Kitsap District?

Bainbridge Island

Bremerton Fire

Central Kitsap

North Kitsap

Olympic Ambulance- Bremerton

Poulsbo Fire

South Kitsap

Do you have a Washington Credential?

Yes, I have a WA credential. (Include Number)

No. Applying for initial certification.

No. I have a license from another state

Upload your WA Credentials card

Choose File

Upload your NREMT Credentials card

Choose File

Before your DOH application is signed off, you must pass the protocol test.

Protocol test

Please check off the following, indicating you understand and agree with them.

I understand I cannot provide independent patient care, until I have passed my protocol test, received my DOH credential and appear on my agency roster.

I understand passing score for the protocol test is 80%.

If I fail the test, per policy I must wait 7-21 days to retake the test again.

I understand this test is a proctored closed book exam, which I need to contact my medical officer to administer.

Protocol Test Date *

What date do you want to take the protocol test?

All providers practicing in Kitsap County must complete their level of core training. When onboarding, please attach to this form, the following documentation.

ACLS

My ACLS card is current

I am getting my ACLS card

Date of ACLS Expiration

ACLS card

Choose File

PALS Card

Yes, my PALS card is current

No, I need to renew my PALS card

Date of PALS expiration

Upload your PALS card

Choose File