MCI Trailer Standby Use

MCI Trailer Standby Use Agreement

Please fill out the following form in order to reserve an MCI Trailer for a standby event.

* Required Information

Agency

Agency Representative

MCI Trailer Requested

Today's Date

Agency Representative Email

Standby Purpose

Description of the public event, training excrise, drill, or other that the Trailer is need for

Trailer Pick up Date

Trailer Pick up Time

Trailer Return Date

Trailer Return Time

Agreement:

Trailor inventory has been performed and is accepted for standby use.

It is the responsibility of the accepting agency to assure Trailer security and reasonable protection from human or natural damages.

Trailer will be in accepting agency's custody on the above dates.

Trailer is NOT to be used as a supply resource or distrubution center during routine standby.

Trailer supplies are NOT to be used for routine patient care.

Do NOT open locks or break seals on itemized/counted goods or supplies during routine events.

Accepting agency will notify SEMAEMS repersentative of any issues, concerns, or problems with the Trailer as soon as possible.

A follow-up inventory will be performed on Trailer when retrieved from the event. Accepting agency agrees to repair /replace items that are determined to be broken or missing as of follow-up inventory.

Trailer is to be towed/re-located only by authorized operators; proof of appropriate insurance may be required.

Other event-specific stipulations may be required by SEMAEMS

Additional Information

Initials

By submitting this form you are taking responsibility for the Trailer and agreeing to the above statements

Thanks for submitting! We will be in contact with you shortly.

824 Oak Street, Suite 207
Brockton, MA 02301

508.946.3960

ems@semaems.com

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