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    Form FA-1: 2017 Fire Equipment Certification For Fire State Aid Payable in 2018

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    Bobd
    This document is a certification form for Minnesota fire departments to report their equipment and personnel as of December 31, 2017 in order to receive fire state aid payable in 2018. It requires departments to provide contact information and answer questions about whether they have been providing service for at least one year, have at least 10 active firefighters, hold regular meetings and drills, house equipment in a good building, have methods to receive fire alarms, have backup apparatus if responding outside city limits, and have specific motorized equipment including pumps, tanks, hoses, extinguishers, ladders, tools, protective gear, and lighting. The completed form must be submitted by March 15, 2018 to avoid penalty and certifying signatures are required from the clerk

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    Form FA-1: 2017 Fire Equipment Certification For Fire State Aid Payable in 2018

    Uploaded by

    Bobd
    39 views1 page
    This document is a certification form for Minnesota fire departments to report their equipment and personnel as of December 31, 2017 in order to receive fire state aid payable in 2018. It requires departments to provide contact information and answer questions about whether they have been providing service for at least one year, have at least 10 active firefighters, hold regular meetings and drills, house equipment in a good building, have methods to receive fire alarms, have backup apparatus if responding outside city limits, and have specific motorized equipment including pumps, tanks, hoses, extinguishers, ladders, tools, protective gear, and lighting. The completed form must be submitted by March 15, 2018 to avoid penalty and certifying signatures are required from the clerk

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    Fire Equipment Certification

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    fsa

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    This document is a certification form for Minnesota fire departments to report their equipment and personnel as of December 31, 2017 in order to receive fire state aid payable in 2018. It requires departments to provide contact information and answer questions about whether they have been providing service for at least one year, have at least 10 active firefighters, hold regular meetings and drills, house equipment in a good building, have methods to receive fire alarms, have backup apparatus if responding outside city limits, and have specific motorized equipment including pumps, tanks, hoses, extinguishers, ladders, tools, protective gear, and lighting. The completed form must be submitted by March 15, 2018 to avoid penalty and certifying signatures are required from the clerk

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    39 views1 page

    Form FA-1: 2017 Fire Equipment Certification For Fire State Aid Payable in 2018

    Uploaded by

    Bobd
    This document is a certification form for Minnesota fire departments to report their equipment and personnel as of December 31, 2017 in order to receive fire state aid payable in 2018. It requires departments to provide contact information and answer questions about whether they have been providing service for at least one year, have at least 10 active firefighters, hold regular meetings and drills, house equipment in a good building, have methods to receive fire alarms, have backup apparatus if responding outside city limits, and have specific motorized equipment including pumps, tanks, hoses, extinguishers, ladders, tools, protective gear, and lighting. The completed form must be submitted by March 15, 2018 to avoid penalty and certifying signatures are required from the clerk

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Form FA-1

    2017 Fire Equipment Certification for Fire State Aid Payable in 2018
    Submit by email to [email protected] or by mail to Minnesota Revenue, Mail Station 3345, St. Paul, MN 55146-3345

    All fields must be completed and all questions answered. The answers should reflect your department’s equipment and
    personnel as of December 31, 2017. This form must be submitted by March 15, 2018, to avoid penalty.
    Answering “No” to any question will not affect your aid amount, but may affect qualification for aid. (Minn. Stat. § 69.011, subd. 4)

    Name of Fire Department Street Address

    County Where Fire Department is Located City, State, Zip

    Name of Person Filling Out Form Phone Number

    1. Has your fire department provided service for at least one year prior to December 31, 2017?
    Yes No
    2. Does your fire department have at least 10 active firefighters, including a chief and assistant chief?
    Yes No
    3. Does your fire department hold regularly scheduled meetings and frequent firefighting drills?
    Yes No
    4. Is your equipment housed in a building of good construction with facilities for care of hose and equipment?
    Yes No
    5. Does your fire department have a reliable and adequate method of receiving fire alarms by telephone, paging
    system, or with electric siren and suitable means of sounding an alarm?
    Yes No
    6. If response is provided to calls from outside the corporate limits of the municipality where the fire department is
    located, does the department have at least one other piece of motorized apparatus remaining within the corporate
    limits, or a written agreement for a neighboring fire department to assist on a second call?
    Yes No Not applicable (no response outside of corporate limits)

    7. Does your fire department have a motorized fire truck equipped with the following items?
    a. Motorized pump Yes No
    b. 250-gallon or larger tank Yes No
    c. Fire hose – two lines with combination spray and straight
    stream nozzles, and at least 300 feet 1” or larger hose Yes No
    d. Five-gallon hand pumps/tank extinguisher or equivalent Yes No
    e. Dry-chemical extinguisher or equivalent Yes No
    f. Regular and extension ladders Yes No
    g. Pike poles Yes No
    h. Crow bars Yes No
    i. Axes Yes No
    j. Hand lights Yes No
    k. Fire coats, helmets, and boots Yes No

    I certify that the above information is true and correct. (Both lines must be checked and signed.)

    Signature of Municipal Clerk or Secretary of Independent Nonprofit Firefighting Corporation Date

    Signature of Fire Chief Date

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