Fire/EMS Detail Request Form

2. This form is used to request a detail of Fire and EMS personnel at your event or to request Bedford Fire Personnel to provide Fire Watch coverage during fire alarm/sprinkler system downtime. Fire/EMS details should be scheduled to begin a minimum of 30 minutes before the event start time and end at least 30 minutes after the event end time. Please contact Captain Tim Lavoie (tlavoie@bedfordnh.org 603-792-1372) with any questions.

   This form is used to request a detail of Fire and EMS personnel at your event or to request Bedford Fire Personnel to provide Fire Watch coverage during fire alarm/sprinkler system downtime. Fire/EMS details should be scheduled to begin a minimum of 30 minutes before the event start time and end at least 30 minutes after the event end time. Please contact Captain Tim Lavoie (tlavoie@bedfordnh.org 603-792-1372) with any questions.

4. Exposition type events require a minimum of (2) personnel. Fireworks details require a minimum of (2) personnel and a FD Forestry Truck. (The Bedford Fire Department reserves the right to require additional personnel to achieve a level of safety determined by the Fire Prevention Division).

   Exposition type events require a minimum of (2) personnel. Fireworks details require a minimum of (2) personnel and a FD Forestry Truck. (The Bedford Fire Department reserves the right to require additional personnel to achieve a level of safety determined by the Fire Prevention Division).

6. Event Information

8. Name of Event*

9. Location of Event*

11. Brief Description of Event*

12. Event Starts
    Event Starts

    Event Starts

13. Event Ends
    Event Ends

    Event Ends

15. Expected Number of Attendees*

16. Detail Starts
    Detail Starts

    Detail Starts

    At least 30 minutes prior to Event Starts

17. Detail Ends
    Detail Ends

    Detail Ends

    At least 30 minutes later than Event Ends

19. Multi-Day Events - Dates & Times

    For Multi-Day Events Enter Event Dates and Times Here

21. Number of Firefighter/EMTs Requested*

    $60.00 per hour (minimum of 3 hours)

22. Fire Department Apparatus Requested (Ambulance, Engine, Forestry)

    Rate Varies (http://www.fema.gov/schedule-equipment-rates)

26. Event Contact Information

28. Name

29. Email Address

31. Address

33. City

34. State

35. Zip Code

37. Phone Number

38. Fax Number

42. Event Billing Information (If Different than Contact Information)

44. Name

45. Email Address

47. Address

49. City

50. State

51. Zip Code

53. Phone Number

54. Fax Number

Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field