• Protect fire fighters and paramedics.
  • Preserve relevant and important evidence.
  • Collect and organize information on health, safety, occupational disease, and compensation.
  • Make sure fire fighters and paramedics receive full and complete compensation.
  • Make sure fire fighters and paramedics are treated fairly and fully under the law.
 

To report an injury, call our emergency hotline at 888.729.7600 OR complete and submit the Workplace Safety Report Form Below:

DATE OF INJURY BEING REPORTED:

TIME INCIDENT OCCURRED:

LOCATION OF INCIDENT:

PLEASE DESCRIBE WHAT HAPPENED: *

TYPE OF INJURY WHICH WAS SUSTAINED:

COULD THIS DANGER HAVE BEEN PREVENTED?

 Yes No

WHO WAS HURT?

Name of Person Who Was Injured:*

PERSON REPORTING THE INCIDENT:

FIRST NAME:

LAST NAME:

ADDRESS:

ADDRESS: (line two)

CITY:

STATE:

ZIP CODE:

PHONE NUMBER:

Ext.

EMAIL:*

May we forward information about this incident to appropriate agencies or organizations? *

 Yes No

May we contact you? *

 Yes No

By submitting this information, you have consented to share this information with government agencies and others who are involved and concerned with such safety issues. Submitting information to the First-Alert Program does not create any contractual relationship or duty between you, the Program, or its sponsors. Please check the box to indicate that you have read and understand that by submitting your information, you have no obligation.*:

*Information is required. You must click the check box to indicate that you have read and understand the terms of submitting your information.

 
 
 

•A fire fighter who was electrocuted while fighting a residential fire when power lines around the residence were not de-energized;

• A fire fighter who sustained a brain injury when the folding step on his engine broke, causing him to fall and strike his head on the concrete floor of the firehouse;

• A paramedic who was seriously injured by a defective bench attachment in the rear of his ambulance.

In all of these matters, quick reporting and response are essential to protecting and preserving the rights of first responders.