Engineering Request
This form is used to submit any concerns, damage reports, or maintenance needs for LCVRS owned apparatus including on-board radios, MDT, and cot restraint / PowerLoad systems. For concerns about removable equipment including the patient care Toughbook, actual cot, portable radios, etc., please email

Pictures or other supporting documentation can be emailed to

Email address *
Which apparatus is this report for? *
Is the issue the result of an accident? *
Is the unit currently in service? *
Please describe the problem, issue, or concern below: *
Your answer
Never submit passwords through Google Forms.
This form was created inside of Report Abuse - Terms of Service - Additional Terms