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.
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).
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