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Emergency Medical Services (EMS) Forms

  • EMS Office Forms 


EMR / EMT / Paramedic Application Forms and Documents

  • Protocol Receipt Acknowledgement Form
  • EMR and EMT Initial Checkoff 12-2021
  • EMR and EMT In-State Transfer Checkoff 09-2022
  • EMR and EMT Reciprocity Checkoff 6-2020
  • PM Upgrade or Initial - WA Trained - Checkoff 1-2019
  • PM In-State Transfer Checkoff 10-2020
  • PM Reciprocity Checkoff 6-2020

EMS Evaluator (ESE) Renewal

  • WA DOH EMS Evaluator (ESE) Partial Online Renewal Option
  •  WA DOH EMS Evaluator (ESE) Partial Online Renewal Option Pierce County EMS MPD Specific Reminders for ESE Renewal
  •  Pierce County EMS MPD Specific Reminders for ESE Renewal Skills Competency for ESE Renewal Only Form

Paramedic Continuing Education / Skills Record

  • First Certification Period
  • Subsequent Certification Periods
  • Paramedic Reciprocity Skills Verification
Miscellaneous Forms
  • Pierce County AED Registration Form
  • Pierce County OTEP Summary Form
  • Revised Washington State DOH Training, CME and Skills Maintenance Documentation
  • Personal Status Changes
  • Protocol Change Request Form
  • Suggest Topics for EMS Conference
  • Ambulance/Aid Equipment List
  • Portable Order for Life Sustaining Treatment (POLST)
      POLST Form  To order POLST forms or brochures visit the WSMA website


  1. EMS_clean

     Pierce County EMS Office



    2501 S. 35th St. Suite D
    Tacoma, WA 98409

    For emergencies:
    Call 9-1-1

    Ph: (253) 798-7722
    Fx: (253) 798-2200

    Contact Us



    Hours


    Monday - Friday
    8 a.m. – 4 p.m.


    DEM FacebookEmergency Information BlogPierce County Twitter

  1. EMS Council
  2. EMS Forms
  3. Other Publications

How can we help?

  1. Pierce County wants to hear from you. Please select one of the following to talk to elected officials and staff, or to report problems in our community.

  1. Send a message
  2. Report an Issue
  1. File a Police Report
  2. Property Information
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  1. Emergency Management Logo

Contact Us

  1. 2501 S. 35th  St. Suite D
    Tacoma WA 98409
    Contact Us

    Ph: 253-798-6595
    Fx: 253-798-3307

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