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Fire Service Resource Form
Home
Fire Service Resource Form
Fire Service Resource Form
[email protected]
January 21, 2023
August 22, 2023
Please enable JavaScript in your browser to complete this form.
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
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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. (EXAMPLE: Engine 2000 / 6 seats / 1000 GAL/1500 GPM / RIT) 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.
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