City Of Dayton Police & Fire Department Local Business Emergency Contact Form (Page 2 of 2) in pdf

City Of Dayton Police & Fire Department Local Business Emergency Contact Form Page 2

First Contact

Name:_______________________________

Title/Position:________________________

Phone:_______________________________

Alternate Phone:______________________

Second Contact

Name:_______________________________

Title/Position:________________________

Phone:_______________________________

Alternate Phone:______________________

Third Contact

Name:_______________________________

Title/Position:________________________

Phone:_______________________________

Alternate Phone:______________________

Alarm System:____ Yes ____ No

Alarm Audible:____ Yes ____ No

Auto Dialer:____ Yes ____ No

Alarm Panel Location:_____________________________

Is your alarm system monitored by a central station?: ____Yes ____No

Alarm Company Name:_________________________________ Phone:_________________________

Alarm Types: ____Burglar ____ Hold Up ____Panic ____ Fire ____ Medical

Does the building have a standpipe/sprinkler system?: ____ Yes ____ No

If yes, please specify the location of the Fire Department Connection:___________________________

____________________________________________________________________________________

Roof Type: ___________________ Stories: ___________

Square Feet:_____________

Elevator: ____ Yes ____ NO

Elevator Manufacturer:____________________________

SPECIAL HAZARDS/ADDITIONAL INFORMATION

(Please include any hazardous materials or notes that may be pertinent about your business/building ie: guard

dog, hazardous chemicals, etc.)

__________________________________________________________________________________________

____________________________________

Date:______________________________

Owners Signature

 If you need to update your information you may print a form from our website

submit it to the above address or contact the Police or Fire Departments at the above numbers.

NOTE: All this information is confidential and stored at our dispatch center, Police Station, & Fire Station. This

information is not accessible to anyone other than our public safety employees and is used for emergency purposes

only.

City Of Dayton Police & Fire Department Local Business Emergency Contact Form Page 2