Northwest Region Prehospital Care Program - Request for Certification (RTP)

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Request for Certification (RTP)

Northwest Region Prehospital Care Program
290 Munro St., Suite 2400, Thunder Bay, ON P7A 7T1
Phone: (807)684-7950 Fax: (807)683-3211

Request for Certification

Return to Practice

First day of LOA

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Return to Practice Date

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BLS Successful Completion Date

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SECTION A

(to be completed by the Employer Requesting Certification)

Paramedic Name

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Phone Number

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Address

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EHS Number

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Employment Status

NAOTEMS NWEMS RRDPS SNEMS - City SNEMS - District Invalid Input

EMPLOYER SUPPORTING CERTIFICATION

The above paramedic meets all qualifications for employment under the Ontario Regulation 257/00 under the Ambulance Act(*)

YES NO Input required

The above paramedic is physically capable of performing all duties within their scope of practice with no restrictions. (*)

YES NO Please select Yes or No

Name of submitter(*)

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Submitter's EMail Address

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Please check the box below as your signature verifying that all the information provided is true and accurate. (*)

All information provided is true and accurate This is required to continue. If the information is incorrect or false please close this page.

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SERVICE FORMS
Request for Certification (RTP)
Request for Certification
Cross Certification Form
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Ontario EMS and Base Hospitals work in collaboration to ensure safe quality pre-hospital patient care is provided to every patient.

Northwest Region Prehospital Care Program
290 Munro St. Suite 2400
Thunder Bay, Ontario
P7A 7T1

Phone: (807) 684-7950
Fax: (807) 683-3211
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
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