Emergency Services / Fire Coordinator / Training

Oneida County Emergency Management Fire Prevention and Life Safety Equipment

Online Request Form (Life Safety House)

( * ) indicates required field

Contact Person

Department Name

Fire Department Name

Phone Number

Alternate Number

Fax Number

Date

Start Time

End Time

Event Start Notes

Event End Notes

Address of Event

Event Phone Number

Delivery Address (if different)

For the Life Safety House, describe exactly where to place the trailer

Agreement

I agree that while in the above listed organization’s possession, we will follow all policies for the Life Safety House. In addition, I agree to notify the county Fire Coordinator’s Office of any damages to the Life Safety House or any of its contents. We

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