Fire Department Submission Summary

Mail To:

State Fire Marshals Office
500 James Robertson Pkwy
Nashville, TN 37243

Fire Department Legal Name:

FDID:

Primary County:

Mailing Address:

City:

State:

Zipcode:

Business Phone:

Business Fax:

Website:

Primary Email:

Organization Type

Local Government (County, City, Town)	Private, nonprofit
Federal Government	Private, for-profit

Fire Department Personnel & Characteristics

Volunteer Firefighters		An active firefighter who receives no financial compensation for their services other than life/health insurance, workmen's compensation insurance.
Paid On Call/Stipend Firefighters		An active firefighter who receives a nominal fee based on per event basis.
Career Firefighters		An active firefighter who receives financial compensation for their services.
Total Firefighters		A member in good standing who is qualified to respond to and extinguish fires and has actively participated in firefighting in the past year.
Trained Firefighters		How many firefighters have completed the basic firefighter 64-hour course and live burn or obtained FFI level?
Support Personnel:		Any member in good standing whose primary job function is administrative or operational and does not actively participate in firefighting. Include auxillary members.
Total Personnel		Combined total of all personnel.

Budget (Provide the average for the last 3 years)

What was your department's average annual operating budget?	$
What was your department's average annual training budget?	$
What was your department's average annual fire prevention budget?	$

What is the source of your department's funding? (Check all that apply)

Donations/Fundraising (choose below)	Taxes (choose below)	Subscriptions	Grants	Other
Private Citizens	Situs Tax
Government Entity or Entities	Fire District Tax
	Municipal Taxes
Primary Source of Funding:

Highest Ranking Fire Official's Printed Name Highest Ranking Fire Official's Signature Date

Highest Ranking Elected Official's Printed Name Highest Ranking Elected Official's Signature Date

Structural Fire Suppression	Wildland Fire Suppression	Airport Rescue Firefighting (ARFF)
Maritime Operations/Firefighting	Occasional Fire Prevention Program	Formal/Year-Round Fire Prevention Program
Fire Investigations	Who conducts primary cause and origin determination for fires?:
Rescue Operations Level	Rescue Technical Level
Haz-Mat Operational Level	Haz-Mat Technical Level
Basic Life Support	Advanced Life Support	EMS Transport Provided