Hazardous Chemical Emergency Notification

City of Novi Fire Department
Emergency Contact and Property Information

(*) = Required
 

Business Name (*):
Complex Name:
Address (*):		Suite:
Phone (*):		Fax:
Type of Business (*):
Business Website:

Emergency Contact #1
Name:		Title:

Phone:

Mobile:

Email:

Emergency Contact #2
Name:		Title:

Phone:

Mobile:

Email:

Do you own or lease the building this business is located in?:
Own Lease

Property/Comples Owner or Manager:

Property Contact #:		Email:

Does the business have an Automatic External Defibrillator?:

Yes No

How many?:

Location of the AEDs:
Business Occupany Size (Sq. Ft.):
Building Size (Sq. Ft.):

Fire Sprinkler System:
Yes No
Fire Alarm System:
Yes No
Burglary Alarm System:
Yes No

Alarm Panel Location:
Alarm Monitoring Service:
Alarm Phone:
Business Hours (*):
No. of Employees (*):

By checking the box, I hereby state that the information supplied is complete, accurate and without intentional omissions. I also acknowledge that the information will be used for government purposes only.:

Name:	Title:

Form 3 of 3