| PSAP Name: |
|
| Physical Address: |
|
| Director/Manager: |
|
| Telephone: |
|
| Primary Contact: |
|
| Secondary Contact: |
|
| Telephone: |
|
| 24x7 Number: |
|
| CPE Manufacturer: |
|
| CPE Model: |
|
| CAD Manufacturer: |
|
| CAD Model: |
|
| Mapping Manufacturer: |
|
| Mapping Model: |
|
| Radio System Manufacturer: |
|
| Radio System Description: |
|
| Emergency Medical Dispatch Program (EMD): |
|
| EMD Version: |
|
| Mobile Data Computer Manufacturer (MDC): |
|
| MDC Model or Version: |
|
| Participating In TERT Deployments: |
Yes
No |
| Participating in MEMAC |
Yes
No |
|
Staffing Types:
|
| Call Takers Only (Select Discipline) |
Law Enforcement
Fire
EMS
Public Safety (All 3 Disciplines) |
| Radio Dispatchers Only (Select Discipline) |
Law Enforcement
Fire
EMS
Public Safety (All 3 Disciplines) |
| Telecommunicator (Both call taker & Radion Dispatcher) |
Law Enforcement
Fire
EMS
Public Safety (All 3 Disciplines) |
| Shift Length: |
8
10
12 |
| Other |
|
|
Number of Positions:
|
| Call Takers |
|
| Radio |
|
| Telecommunications |
|
| Other |
|
| Please list all the law enforcement agencies you serve: |
|
| Please list all the Fire agencies you serve: |
|
| Please list all the EMS agencies you serve: |
|
|
