Fire Service Resource Form - Franklin County

Fire Department *

Fire Chief *

First

Last

Name of Person Completing Survey (If Not Chief)

First

Last

Title / Rank

Total Number of Stations

Department Main Station Address *

Address Line 1

Address Line 2

City

State

Zip Code

Main Office / Business Phone *

24/7 Emergency Contact Number *

Fire Chief's Cell Phone *

Fire Chief's Cell Phone Provider *

Fire Chief's Personal E-Mail *

Department Main E-Mail *

Primary Local Dispatch Center *

Department Personnel Demographics

Total Number of Career Firefighting Personnel *

Total Number of Paid on Call Firefighting Personnel *

Total Number of Volunteer Firefighting Personnel *

Total Number of Licensed EMS Personnel *

Total number of personnel actively responding to EMS emergencies that are licensed by IDPH to provide patient care. This number can include firefighters, engineers, and EMS personnel.

Total Number of Certified Fire Instructors *

Total number of personnel currently certified as Instructor I, II, or III.

Total Number of Certified EMS Instructors *

Total number of personnel currently licensed by IDPH as an EMS instructor.

Total Number of Certified Arson Investigators *

Total number of personnel currently certified as Arson Investigator.

Total Number of Chaplains *

Additional Comments / Information Concerning Personnel *

Apparatus Demographics

Below you find a survey concerning your apparatus. Please include all apparatus you have available and as much information concerning special equipment as possible. Please use the format: Apparatus Number / Seating / Gallons Carried / Special Information. If you reach a section of the survey you do not have, just put N/A.

Engines *

Please list each Engine, Staffing Capability (number of seats) and amount of water carried. Please include any additional information that would be of benefit such as extrication, rescue, active shooter, RIT or other special equipment carried.

Trucks (Ladder/Quint/Tower) *

Please list each Truck, Staffing Capability (number of seats) and amount of water carried. Please include any additional information that would be of benefit such as extrication, rescue, active shooter, RIT or other special equipment carried.

Tenders *

Please list each Tender, staffing capability (number of seats) and amount of water carried. Please include any additional information that would be of benefit such as special equipment carried and pumping capability.

Brush Engines / UTVs *

Please list each Brush Engine/UTV, staffing capability (number of seats) and amount of water carried. Please include any additional information that would be of benefit such as special equipment carried.

Ambulances *

Please list each Ambulance, staffing capability (number of seats). Please include any additional information that would be of benefit such as special equipment carried.

Squads (Light/Medium/Heavy) *

Please list each squad and level of capability. Please include any additional information that would be of benefit such as special equipment carried. If you have already listed the vehicle in another section do not list it again (example: Licensed Non-Transport Engine).

Non-Transport EMS Vehicles (copy) *

Please list each licensed EMS non-transport vehicles, staffing capability (number of seats). Please include any additional information that would be of benefit such as special equipment carried. If you have already listed the vehicle in another section do not list it again (example: Licensed Non-Transport Engine).

Command / Chief Officer Vehicle *

Please list each Command / Chief vehicle and staffing capability (number of seats). Please include any additional information that would be of benefit such as special equipment carried. If you have already listed the vehicle in another section do not list it again (example: Licensed Non-Transport EMS).

Support Vehicles *

Please list each support vehicle and staffing capability (number of seats). Please include any additional information that would be of benefit such as special equipment carried. If you have already listed the vehicle in another section do not list it again (example: Licensed Non-Transport EMS).

Special Resources / Response Capabilities *

Please list each special resource your Department has. This could include specialized units such as REHAB, Boats, Dive Trailers, HAZMAT equipment trailers, ect. Please include any additional information that would be of benefit such as special equipment carried. If you have already listed the vehicle in another section do not list it again.

Reserve Apparatus *

Please list each any reserve engines, trucks or apparatus that are considered RESERVE only that you have not previously listed.

Additional Resources / Information *

Use this section to list any other special resource, capability, or information that you would like to include.