Schedule A Ride-Along
Observer Program / "Ride-Along"
Daisy Mountain Fire & Medical’s Observer Program was created to acquaint the citizens of the fire district with a better understanding of the job of a firefighter. An effective ride-along program can serve to enhance public relations as well as encourage individuals pursuing a career in the fire service or interested in what an average shift looks like for a firefighter.
In order to participate in our Observer Program, you must be 18 years of age or older. You must obtain permission from the company officer, who will be overseeing you during your ride-along. Once you are granted permission from the on-duty Battalion Chief, you must fill out and sign a "Waiver of Liability" and provide a photo ID.
Observers are to be dressed in a manner that will not be detrimental to the image of Daisy Mountain Fire & Medical; any dress or clothing deemed inappropriate by the crew or company officer will not be allowed. Company officers are responsible for all individuals at, in, and/or around department property and reserve the right to terminate an observer's ride-along if the "rider's behavior or clothing" is deemed inappropriate. Safety is our number one priority for everyone within Daisy Mountain Fire & Medical. Therefore, shorts, open-toed shoes, or other apparel considered to constitute a safety hazard will not be permitted.
Among the points to remember during your ride along:
- A company officer may refuse to authorize an observer on his or her duty day.
- It is imperative for the observer to follow all directions and commands of the company officer or crew.
- A typical ride along will be scheduled from 0800-1200 unless approved by company officer.
- Observers are not allowed to be involved in operations.
To schedule a Ride-Along, please contact Daisy Mountain Fire & Medical at ridealong@dmfd.org
DAISY MOUNTAIN FIRE DISTRICT CITIZEN OBSERVER PROGRAM (RIDE-ALONG)
PARTICIPANT LIABILITY WAIVER AND RELEASE FORM
BY SIGNING THIS LIABILITY WAIVER AND RELEASE FORM, UNDERSIGNED UNDERSTANDS, ACKNOWLEDGES, AND AGREES AS FOLLOWS:
1. Participant (and/or my minor child) desires to participate in the Daisy Mountain Fire District Citizen Observer (Ride-Along) Program (the “Program”). Participation in the Program includes, without limitation, respon4ing in Fire District vehicles and observing the Fire District operating at emergency and non-emergency scenes and incidents (such as fire, medical, and service calls) which may occur on and away from Fire District property and facilities.
2. In exchange for being permitted to participate in the Program, Participant (for myself and on behalf of any minor child) agrees to sign this Liability Waiver and Release Form (the “Release”). I (and on behalf of any minor child) agree to waive, release, hold harmless, indemnify, and forever discharge the Daisy Mountain Fire District, its officers, Fire Board, employees, agents, and volunteers (collectively “the District”) from any and all liability, claims, and causes of action against the District relating to any injuries, death, or damages I receive or incur of any kind caused, or alleged to be caused, in whole, or in part, by the negligence, acts, or omissions of the District.
3. I understand and acknowledge that by participating in the Program, there are known and unknown risks and dangers which may cause personal injury, death, or property damage arising from, or related my/our participation. These risks include, but are not limited to, injury, illness, or death from vehicle or other accidents, residential, industrial or wildland or brush fires, exposures to bodily fluids, infectious diseases, hazardous materials, and allergies to food or food related products.
4. I understand and agree that by signing this Release, I (and on behalf of my minor child) agree not to file any legal or other actions or make any claims against the District for any injury or illness sustained by me or my minor child. I recognize that this means I will not and cannot recover any money, compensation, reimbursement, or damages from the District from my/our participation in the Citizen Observer Program.
5. When participating in the Program, I understand and agree that I (and/or my minor child) will be observing only and will NOT be otherwise participating in any emergency or non- emergency incidents or calls.
6. I understand and agree that I knowingly and voluntarily assume and accept any and all risks associated with my/our participation in the Program. I further represent that I (and my minor child) is/are physically capable of participating in the Program.
7. I agree to obey and follow all rules, instructions, orders, regulations, and commands given to me by District employees/crews. A District supervising employee may determine, in his/her sole discretion, to cancel or terminate the activity or my/our participation in the Program at any time for health, safety, or other reasons.
8. I agree to be appropriately attired during my participation in the Program. Unless otherwise advised, shorts, dresses, cut-offs, and open-toed shoes are not permitted. The undersigned agrees to act in a professional and courteous manner at all times.
9. During this activity, In the event I (or my minor child) become injured or ill, I hereby consent and authorize the District to administer any necessary emergency medical treatment and provide transportation to an appropriate medical facility for evaluation and treatment. I further agree that I will assume and pay, hold harmless, and indemnify the District from all liability, medical costs and expenses related to any such medical treatment and transport.
10. I understand that any and all information pertaining to patients or customers of the Daisy Mountain Fire District is strictly confidential and protected by federal and state laws and that I will not use or disclose patient or other information in any way, unless authorized by the District in writing. Any patient information or confidential information, in any form, that I see or hear while a guest/trainee must stay at the District when I leave.
11. I agree that I will not take any photos, video recordings, audio recordings, photo copies etc. of any kind while observing an active incident unless authorized to do so by the supervisor on duty. Obtaining photographs, video/audio recordings of patients or patient information while the crew is involved in patient care is strictly prohibited.
12. I further understand and agree that this Waiver and Release of Liability and all Claims is intended to be as broad and inclusive as permitted by Arizona Law. If any provision or term contained in this Release is determined to be invalid or unenforceable, the remainder shall be enforceable and remain in full force and effect.
13. I understand that my failure to comply with the requirements contained within this agreement may result in immediate suspension or termination of my privilege to ride along and observe or train with the District.
14. This Waiver and Release is binding upon all parties hereto and undersigned’s heirs, executors, administrators, personal representatives, agents, successors, and assigns.
Guest/Trainee HIPAA Training Handout
Daisy Mountain Fire District (“DMFD”) fully embraces our responsibility of securing and protecting the privacy of our patients. As a guest/trainee, it is expected that you will follow all DMFD policies and procedures regarding patient privacy. Please review the summary below prior to your observation/trainee shift(s).
1. What is HIPAA? (Health Insurance Portability and Accountability Act)
Federal Law passed by Congress in 1996, applies to healthcare provider covered entities. DMFD is a covered entity and bound to the full HIPAA regulations.
2. What is Protected Health Information (“PHI”)?
Any individually identifiable health information that is created, received or maintained by a covered entity is considered PHI. This includes information in any form (spoken, written, photograph or electronic).
3. TPO: HIPAA allows DMFD to share a patient’s PHI for the following:
•Treatment: such as when transferring care at the hospital
•Payment: such as billing for an ambulance transport
•Operations: such as quality control, training, or complaint resolution
In addition, the patient has a right to receive their information. When disclosing PHI, DMFD should only share what is minimally necessary.
4. Breech Notification: In the event of a breech, such as if PHI is lost, stolen, or incidentally disclosed, DMFD is required to investigate, and may be required to notify the patient and the Department of Health & Human Services.
5. Penalties: Failure to comply with HIPAA rules may lead to investigations by the Office of Inspector General, as well as fines and other penalties. It is the policy of DMFD to maintain compliance with all HIPAA rules at all times, including when allowing Trainee/Guest participation.
6. Any guest/trainee who comes in contact with a patient or customer of DMFD is expected to maintain strict confidentiality of that encounter anytime during or after the incident. Cell phone or camera use is prohibited during your participation in the DMFD Guest/Trainee program.
For questions, or to report a breech, contact:
DMFD Privacy Officer: 623-465-7400, or by email: EMS@dmfd.org
I AGREE THAT I HAVE CAREFULLY READ AND FULLY UNDERSTAND THE MEANING OF THIS WAIVER, HIPAA AND RELEASE OF ALL LIABILITY AND CLAIMS AGAINST THE DISTRICT AND THAT I HAVE VOLUNTARILY SIGNED BELOW.