CAYUGA COUNTY BOX ALARM FORM

(Microsoft Excell -

Update)

DEPT. #:

FD NAME:

BOX NAME:

BOX LOCATION:

STRUCTURE FIRE

ALARM

RIT

LEVEL

PRIMARY DISPATCH RECOMMENDATIONS

UNIT(S)

1st

Auto Replace 1

Auto Replace 2

2nd

Auto Replace1

Auto Replace2

3rd

Auto Replace1

Auto Replace2

4th

Auto Replace 1

Auto Replace 2

5th

Auto Replace 1

Auto Replace 2

R.I.T. STARTED ON:

(indicate 1st Alarm, Working Fire, 2nd Alarm & Greater, or Upon Request)

WORKING FIRE  ALS AMB. :

(yes or no)

WORKING FIRE  REACTIVATION:

(yes or no)

UTILITY

ELECTRIC:

NATURAL GAS:

WATER:

SERVICE

TELEPHONE:

CABLE TV:

OTHER:

TEXT

(Limited to 2 lines of 25 Characters Per Line)

AUTHORITY:

TITLE:

DATE: