Dublin Borough Police Department 119 Maple Avenue Dublin, Pennsylvania 18917 Voice: 215-249-0272 Fax: 215-249-0857 www.DublinBorough.org Brian C. Lehman Chief of Police
Business Emergency Contact Information The following information is requested by the Dublin Borough Police Department in the event that an emergency would occur at your business. This information is confidential, and is the only way the police are able to make notifications during an emergency. It will not be released, or used for any other reason than its intended purpose. If you change emergency contacts for your business please notify the police department so we can better serve you.
Business Name: ______________________________ Telephone No._____________ Street address, including any P.O. Box number of your business:
__________________________________________________________________ Owners name: __________________________ Contact number: ________________ Normal operating hours? _______________________________________________ Does your business have an alarm system: Yes___ No___ What type: (check all that apply) Burglary __
Is it an audible: Yes ___ No___
Panic __
Smoke __
Fire __
Alarm Co. Name: _______________________________ Telephone No.__________________ Does your business have video surveillance? Yes ___
No ___
Please provide a list of persons to be contacted in the event of an alarm or emergency. List them in the order that you would like them contacted. NAME
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In the event of an emergency situation involving my death or serious injury, I authorize my emergency contacts to receive medical and other necessary information so they may act on my behalf in such activities as banking, medical decisions, health in
Salem Youth Symphony. P.O. Box 1113, Salem, OR 97308 www.salemyouthsyphony.org. 503.485.2244 [email protected]. 2013-â 2014 Emergency Contact Information and Medical Release. 1. First name of student ...