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Alaska Department of Public Safety
Community Risk Reduction Pre-Assessment Form
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* Indicates required question
Email
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Your email
Community
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Your answer
Person completing the questions
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Your answer
Your position
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Your answer
Contact phone
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Your answer
Contact email
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Your answer
Address
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Your answer
Native Corporation (if applicable)
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Your answer
COMMUNITY DEMOGRAPHICS
Community Access?
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Air
On the road system
Ferry
Summer Population
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Your answer
Winter population
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Your answer
Reason for population increase if any?
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Your answer
Square Miles
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Your answer
Local Industry
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Your answer
COMMUNITY RESOURCES
Please list and describe your community's resources
Medical services
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Your answer
Local airport
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Your answer
Mental health
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Your answer
Law enforcement
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Your answer
Who is responsible for the school and do they have access to it 24/7?
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Your answer
Who is responsible for the water treatment facility and do they have access to it 24/7?
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Your answer
Who is responsible for the power plant and do they have access to it 24/7?
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Your answer
Who is the heavy equipment operator?
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Your answer
Other resources
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Your answer
Fire Department Information
Please answer a couple questions regarding your department's current status.
Fire Chief's name and contact information (VPSO if no fire chief is available)
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Your answer
Fire department: Please check all that apply
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Registered with the state
Never registered with the state
Registration expired
All volunteer
Career
Combination: some paid, some volunteer
Level of training: NO training
Level of training: Basic Firefighter
Level of training: Firefighter 1
Level of training: Firefighter 2
Level of training: Hazmat Awareness
Level of training: Hazmat Operations
EMS provided
No EMS provided
Other:
Required
What is the Fire Department budget and how is it funded?
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Your answer
Who is the enabling authority?
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Your answer
How many fire department members/staff are there whether volunteer or paid?
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Your answer
Do they attend regularly scheduled training?
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Yes
No
Other:
What type of fire equipment do you have?
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Your answer
Do you have people to operate the equipment and who is it?
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Your answer
Do you have the ability to maintain the equipment?
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Yes
No
Other:
Community Education Programs
Do you have any current community programs in place such as Safe Kids, bike helmets, smoke alarm installation, etc.?
Your answer
Who currently provides community prevention and education programs?
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Your answer
Has your community received assessments from any other agency? If so, what agency?
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Your answer
Any specific risks or concerns that have not already been identified?
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Your answer
Any additional information you would like to share?
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Your answer
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