DEPARTMENT OF PUBLIC SAFETY HELP DESK FORM

2. Name:

   Please provide your name.

3. Title:

   Please provide your agency role.

5. Agency:

   Please list your agency.

6. Phone Number:

   Please provide the best number to reach you.

8. Email Address:

   Please provide your agency email address.

10. Date:
    Date:

    Drill or exercise date:

11. Start Time:
    Start Time:

    Please provide the drill or exercise start time.

12. End Time:
    End Time:

    Please provide the drill or exercise end time.

14. Exercise or Drill Location:

    Please provide the location of the exercise or drill.

16. Comments:

    Please provide the details of the drill / exercise, and what involvement you need from the 9-1-1 emergency communications center or field communications unit.

18. Master Schedule of Events List:

    Supply the name(s) of the participating companies with clear indication of the participating company's name, the location that the company is to be dispatched to (scene, standby at a specified location), when the company is to be dispatched (initial dispatch, 2nd alarm, separately), the companies status during the drill; and be sure to list a Fire Chief (President for EMS) of the all participating agencies, along with their contact information.

Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field