2. 
4. Information for Chief Officer requesting Accountability Tag
6. First Name*
7. Last Name*
9. Title*
10. Organization*
12. Phone Number (###-###-####)*
14. Email Address
    If you have an Email address please fill this field out.
16. Please provide the following new tag information
18. First Name
19. Last Name
21. ID Number
22. Organization
24. Phone
26. Email Address
28. Select any of options that apply.

    1. Recruit = Probationary, untrained and or enrolled in training program
    2. Support = Fire Police, Drivers and EMS Personnel Only
    3. Exterior = Scene Support, BEFO or Equivalent Qualified, NIMS 100 & 700

    1. Interior 1970 -2010 = FF Essentials, Basic FF 2000, FFI, Physical, Fit Test, OSHA Training, NIMS 100 and 700
    2. Interior 2011 = FF Essentials, Basic FF 2000, FFI, FF Survival, Physical, Fit Test, OSHA Training, NIMS 100 and 700
    3. Interior 2012-Current = FFI, SCBA Confidence, Calling the Mayday, Truck Company Ops, FF Survival, Courage to be Safe, CPR/AED

    1. FAST 1970-2011 = Meets requirements for Interior, FAST, Truck Company Ops, CPR-D Current
    2. FAST 2012 - Current = Meets all requirements for interior FF, FAST
    3. Driver = Scene Support, BEFO, E.V.O.C

    1. Fire Police = NYS Fire Police Certificate
    2. EMS = EMT-D Current
    3. NIMS / ICS Compliant
30. Accountability Tag Certification

    1. I certify firefighter meets requirements for tag request.
32. A digital image needs to be uploaded in order to complete your Accountability Tag Request
34. By submitting this form you acknowledge and understand the provisions of the Accountability Tag Program.
    The coordinators office reserves the right to ask for supporting documentation for any request. State training records may be checked to verify applicable course requirements have in fact been met. By submitting this form the chief of the department is in agreement that all the requirements for the levels are current and up to date. It is the departments Chief's responsibility to revoke and return any tag of any member in their department that no longer meets the requirements of the level (examples would include the firefighters failure to get a fit test or physical as required). Tags should be reviewed by the department's Chief at least on an annual basis and updated requests be sent to this office. New tags will be given to the chief of the department for issue to the member. By submitting the request and issuing the tag the chief is acknowledging an understanding and compliance with the program. Any questions should be submitted in writing to the Fire Coordinator for clarification.
36. When you click send you will be redirected to the Emergency Response and Communications homepage.
Leave This Blank:


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

    This field is not part of the form submission.

40. Submit

* indicates a required field