Fire Marshal


	Emergency Tips from Fire Marshal and Emergency Management Coordinator Andrea Testa

We are required to continually review and update our Township Emergency Operations Plan. Some information is required from our residents to help us better prepare for a major emergency in our community.

We need to know if anyone in your household requires special assistance in the event of any emergency. Special needs include the following: difficulty walking, hearing or vision impariment,

a constant need for oxygen, non-English speaking, or any other problems a resident may have that would make it difficult to evacuate their residence during an emergency.

This information is strictly confidential. This special needs list is maintained in the Chester County Emergency Services Dispatch Center, and the Township's Emergency Management files. This information allows us to quickly direct assistance to persons with special needs during any emergency.

Thank you for your assistance in providing this important information.

Name:

Telephone:

Address:

West Chester, PA


Emergency contact name:

Contact telephone--Home:

Relationship:

Work:

I have the following special needs: (Check all that apply)

I am on oxygen


	I am blind

I am deaf

I am unable to walk or have difficulty walking

I can not speak/read English


	Other special needs:

Please note that this form is not compatible with some internet service providers. If you receive an error message while attempting to submit this information, please email the appropriate information to klehr@westgoshen.org.


	Copyright 2008, West Goshen Twp.