EMERGENCY PREPAREDNESS INFORMATION

This form is intended to collect vital information required to assist Police, Fire, and Ambulance personnel when responding to your home or business in the event of an emergency. Please take the time to complete the entire form before you submit it. When you have finished filling out the form click the submit button located at the bottom of the form. Your emergency responders appreciate your cooperation in performing this invaluable service.

PLEASE REMEMBER TO ANSWER ALL QUESTIONS

Type of Location
BUSINESS / RESIDENCE NAME
BUSINESS / RESIDENCE NAME
PROPERTY OWNERS NAME
PROPERTY OWNERS NAME
Emergency Contact Person(s): Who will respond with a key in the event of an emergency? It is highly recommended using someone that can respond within 15 minutes
Name
Name
Who will respond with a key in the event of an emergency? It is highly recommended using someone that can respond within 15 minutes.
Name
Name
Name
Name
PROVIDE YOUR CONTRACTORS NAME AND TELEPHONE NUMBER THAT PERFORMS THESE SERVICES:
BUSINESS RESIDENCE LOCATION INFORMATION:
My Business / Residence is on the
of the premise?
Please check all that apply for the above property:
Do you have firearms or reloading supplies on the premise?
Do you have a KNOX Box at your location?
If NO information about Knox Boxes and other Knox Rapid Entry System products can be found at knoxbox.com
Are there any occupant(s) with Special Needs that reside or frequent your home or business?
Please check all that apply:
Does an occupant require a wheelchair or walker for mobility?
Does an occupant require oxygen or special life support equipment while at home?
If required to evacuate during an emergency, will the occupant with special needs require any special equipment, medications, medical personnel or transportation?
Please make sure that you have filled out the above form correctly before submitting it.