EMERGENCY CONTACT UPDATE FORM

The Worcester County Fire Marshal’s Office wants to help you and your business. Each year Police, Fire and EMS units respond to various types of calls at area businesses. Sometimes those calls are after normal business hours and contact needs to be made with someone from the business. To insure that the proper person(s) are contacted please take a moment to fill out the form below. You can also DOWNLOAD and print a copy. Once completed please mail to the address on the letterhead or fax to 410.632.5664. All information will be kept confidential and used only during critical situations. Thank you in advance for taking time to complete this form.

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BOLD Print are mandatory Fields
Email:
Business Name:
Trading As:
BUILDING ADDRESS
Address:
City:		ZIP:
MAILING ADDRESS
Address:
City:		State:   Zip:
Business Phone Numbers:		Alternate Phone:
CONTACT PERSONS
Name:
Address:
City:		State:   Zip:
Phone:		or
Name:
Address:
City:		State:   Zip:
Phone:		or
Name:
Address:
City:		State:   Zip:
Phone:		or
BUILDING INFORMATION
Fire/Burglar Alarm:		Select One Yes - Fire Yes - Burglar Yes - Fire & Burglar Yes - Fire, Burglar & Panic Yes - Burglar & Panic Yes - Panic (Only) No
Alarm Company Name:
Alarm Company ID:		(if Applicable and NOT your password):
Sprinkler System:		Select One Yes No
Knox Box (Lock Box):		Select One Yes No
Knox Box Location:
Additional Information For First Responders. These includes Hazardous Materials on site or other hazards that Police, Fire, and EMS need to be aware:

 

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