DEPARTMENT OF PUBLIC SAFETY HELP DESK FORM

2. Check The Information Type You Are Submitting For the Address.

   NOTE: If submitting information about an individual with a medical condition, use the PA Premise Alert Form.

   Location safety alert (refers to issues involving persons at the location this could be Fire, Police, EMS. 

   Critical Property Information - Referring to hazards with the Property.

4. Residence / Business Name
5. Address

   residence business address

7. Municipality
9. Explain in detail the reason for the location safety alert / Critical property information issue.
11. Information included on this form is the responsibility and the liability of the submitting agency. The submitting agency must notify the other local (home) agencies of the alert. Information will need to be verified, at a minimum annually or where the status at the location changes, by the submitting agency or the alert will be removed form CAD after one year, Information must be submitted by a chief officer (FD) , sergeant or higher (PD), or EMS supervisor (EMS).
13. when completed submit this form to SupportServices@lcwc911.us, or fax to 717-664-1128 for entry into CAD.
15. Submitted By:
16. Agency/Rank
18. Contact #
19. Date
21. Notify Local PD
23. Notify Local FD
25. Notify Local EMS
27. Department of Public Safety Use Only
29. Received by:
30. Date Entered:
32. Expiration Date
33. Date Renewed
35. Make a copy for each service and place in their department file
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field