Seconds Matter, Keep Your First-Responders Informed.
Help your local first-responders better prepare in case of an emergency at your home.

This quick 5 minute survey gives you the opportunity to share critical information that can be used to protect you, your loved ones, and your property.
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What would you like your first-responders to know in case of an emergency at your home?


About This Survey:
Your local emergency services are working together to better prepare ourselves for when you need us most. Through this survey, we are hoping to collect critical information that will allow firefighters and EMTs to more efficiently respond to emergencies at your home. Well informed first-responders can make better decisions, faster.

Time:
5 minutes to complete.

Participating Agencies:
Bedford Fire Department
Bedford Hills Fire Department 
Katonah Fire Department
Katonah Bedford Hills Volunteer Ambulance Corps
Mt. Kisco Fire Department
Pound Ridge Fire Department
 
Fire District *

Select the fire district you pay taxes to.

 
Last name of resident / tenant *

 
House number *

Do not enter apartment unit, that is next.
 
Apartment unit

Leave blank if this does not apply.
e.g. Apartment 4C
 
Street name *

Only enter street name.
e.g. "Babbitt Rd", "Adams St", "Sherwood Ln".
 
Town / Hamlet / Village *

What appears on your address

 
Do any occupants have difficulty moving?

i.e. Individuals that have trouble walking, require crutches, walkers, confined to a wheelchair or bed.
     
 
If a resident does have difficulty moving, can you please share more information about their situation?

e.g. “Elderly female, usually on 1st floor near garage, difficulty walking under own power, typically uses a walker.”
 
Do any occupants rely on oxygen therapy or medical devices?

     
 
If a resident relies on oxygen therapy or a medical device, can you please share more information about their situation?

In addition to oxygen, at home devices may include Suction units, Ventilators, Dialysis, Left Ventricular Assistance Devices (LVAD), etc...

e.g. "80 year old male on required oxygen therapy."
 
Do you have any pets living in the house?

     
 
How many dogs live in your house?

 
How many cats live in your house?

 
If other, describe which type of indoor pet lives here

(Please exclude fish)
 
Was your house built prior to 1940?

Fire Stops: Pre-war houses were typically not built with fire stops in the walls between floors. Fire stops are a building technique using either wood, dry-wall or a combination of materials to slow fire from running up wall voids. If you know your house lacks fire stops in between floors, select Yes. 

(If unsure, leave blank)
     
 
Select all that apply to your home or property


 
Select all that are true about your basement:


 
Does your driveway have an automatic gate?

     
 
What is the length of your driveway (in feet)?

References:
Basketball Court ~ 100 ft
Football Field = 300 ft

 
During an emergency, it is very important that fire engines and ambulances can efficiently access your property and park close to your house. 

Is there anything we should know to efficiently access your home?

e.g. “Rear of property is accessible from our neighbor's driveway at 8 Richmond Lane.”

e.g. “Split driveway, left is #7 and right is #8.”

e.g. "Second dirt access entrance with a gate that leads to rear of property. 300 feet right of the driveway."
 
Do you have an accessible pool, pond, or cistern on your property that a fire truck could come within 20 feet of?

During a fire, engines are able to use nearby water sources but ONLY if they are able to get close enough to draft water from.

***Only select if a fire engine can realistically come within 20 feet of the water source***

 
If there is a nearby pool, pond or cistern, please concisely describe where this water source is located and how a large fire engine would get within 20 feet of the water.

Be sure to describe any gates or fences that may be an obstacle.
 
Is your electricity supplied by Con Ed or NYSEG?




 
Can you concisely describe where your home’s electricity breaker panel is located?

e.g. “Middle of the wall, farthest from garage/basement staircase.”
e.g. “Breaker is hidden in basement closet at the bottom of the stairs.”
e.g. “Located in back utility room of our finished basement. This room is 20 feet from the stairs.”
 
Does your home have a backup generator or power supply that automatically engages during a power outage?

This does not mean portable generators that are manually engaged. During a fire, it is important that firefighters can de-energize the house. If a generator automatically engages after firefighters cut the power, it can be dangerous to those inside.
     
 
If your home does have a stationary generator or power supply that automatically engages during an outage, can you please tell us where it is located.

 
Please select the primary heating method for your home:


 
Are there fixed propane tanks on your property?


 
If there are fixed propane tanks on your property, can you tell us their location and capacity?

e.g. "1,000 gallon tank above ground concealed in the bushes on the left side of our property"
 
List all key holders and cell phone numbers (neighbors also, if applicable)

e.g. Walter White (914) 555-5555
e.g. Jon Snow (914) 555-5555
 
Last question! 

Is there any other pertinent information you would like to share in case we're called to your home for an emergency?

There are no dumb answers!
 
Legal Disclaimer *

Attention Homeowner/Occupant/Renter of Premises and/or the Individual submitting this information for the address entered above i.e. “Submitter”, Data Chief, LLC is acting as a middle entity between you and your local participating Emergency Services for the sole purpose of obtaining actionable yet non-sensitive information relating to your Premises and the property and Structures thereon, in the event the participating Emergency Services are called to be upon your Property or have legal need to be on your Premises. We do not want you to submit any information you may deem critical, sensitive or important to the overall security of your Premises. Although our online database is protected by industry leading security systems, the Submitter understands that no database is 100% secure in the digital age. No information submitted is protected under the Health Insurance Portability and Accountability Act (HIPPA). Data Chief, LLC will make every attempt to share this information with the Emergency Services who are participating in this data collection project. A full list of participating Emergency Services is available on the first page of this survey, after the initial load screen. This information will only be shared with authorized Fire, Rescue or Medical Personnel such as Fire Chiefs, Officers, Chauffeurs and other authorized First Responders to pass along the information you give to on-scene personnel to assist them in their Firematic, Medical or other necessary duties. Emergency Services often provide mutual aid to other departments during emergencies. Participating Emergency Services have the right to share this information with other departments if they so deem the information important enough to share. Neither the sharing of this information with Data Chief, LLC, Data Chief, LLC sharing your information with the participating Emergency Services nor the use of this information by Emergency Services is no guarantee that you will receive better or greater response to a call at your premises. Data Chief, LLC or any of the participating Emergency Services or any authorized organization that receives this information makes no promise that this information will be used. Data Chief, LLC or any of the participating Emergency Service will not follow up to confirm the accuracy of this information. Therefore, Data Chief, LLC or any of the participating Emergency Services can make no guarantees of the accuracy of any of the submitted information. The individual who shares this survey with Data Chief, LLC is also agreeing that he/she/they are sharing this information will the knowledge, support and permission of the other residents of this address. If information is submitted that any resident would like removed from this preplan database, please submit an email to Support@datachief.info. Additionally, it is the resident and/or the individual who submits this survey’s responsibility to update Data Chief, LLC of any changes with the property or home that have occurred due to construction and/or renovation. Any requests for data modification can be submitted to Support@datachief.info. The submitted information will NOT be resold by Data Chief, LLC or by any of the participating Emergency Services. I, the Submitter of this survey, do hereby agree to the terms and conditions listed above.
     
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