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: |
|
|