STATE AMBULANCE LICENSURE MANUAL AND INSPECTION FORMS COMMONWEALTH LICENSURE FORMS: Pennsylvania Department of Health Ground and Air Ambulance Licensure Manual Pennsylvania Department of Health Ground and Air Ambulance Licensure Application Instructions for completing the PA DOH Licensure Application Special Event EMS Plan and Post-event Reporting Form POLICY STATEMENTS AND SAMPLE ROSTERS FOR LICENSURE: Ground Ambulance Service Required Policies Sample Staffing Plans for Ground Ambulance Services Personnel Roster for Ground and Air Ambulance Services Personnel Roster for QRS Services Air Ambulance Service Required Policies Pilot Roster for Air Ambulance Service LICENSURE INSPECTION FORMS: Official 2011 MontCo Drug List (9/2011) PA DOH EMS ALS - BLS Inspection Checklist (7/2011) PA DOH EMS ALS Squad Licensure Inspection Form (7/2011) PA DOH EMS Air (Rotorcraft) Inspection Form (7/2011) PA DOH EMS QRS Inspection Checklist (7/2011) MISCELLANEOUS FORMS: ALS Service Medical Director Signature Form