Emergency Agency Officers Update Form5

FD/Emergency Services Agency

FDID Number | Fire Department Name

Agency Mailing Address

PO Box

City

Zip

General FD/Agency Email

Web Site

Facebook Page

FD/Agency Chief

Cell Phone

First Assistant Chief

Cell Phone

Second Assistant Chief

Cell Phone

EMS Coordinator

Cell Phone

Training Officer

Cell Phone

President

Cell Phone

Number of Active Firefighters

Number of Interior Firefighters

Number of Paramedics

Number of AEMTs

Number of EMTs

Do you have an Hours Program?

Do you have a Junior Firefighter Program?

Comments

Please complete all appropriate fields that apply to your organization/officers. Read all notes at the bottom of the form.

NOTES

It’s imperative that we have cell phone numbers, email addresses and other pertinent contact info for each member of your leadership team as we may need to contact these individuals in an emergency, or non-emergency related to projects, programs or issues affecting your agency and our emergency services community.

Thanks in advance for your cooperation in completing this form and keeping your contact information up to date anytime there are changes in officers.

Connect with us via www.erie.gov/fire, on YouTube, on our Facebook page at: https://www.facebook.com/ErieCountyESU/, and via our Twitter feed: https://twitter.com/ErieCountyESU

Officers for the year