• Incident ID Number (Whatever means you wish for internal identification of this specific event)

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* 1. • Incident ID Number (Whatever means you wish for internal identification of this specific event)

Date of incident

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* 2. Date of incident

City and state of incident for customer premise

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* 3. City and state of incident for customer premise

City and state of receiving central station

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* 4. City and state of receiving central station

Time of incident, including time zone (ET, CT, PT, other)

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* 5. Time of incident, including time zone (ET, CT, PT, other)

10-digit originating phone number (the phone number of the panel at premise in question (xxx) xxx-xxxx) 

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* 6. 10-digit originating phone number (the phone number of the panel at premise in question (xxx) xxx-xxxx) 

Is the panel dialing a DID (local number) or toll free number?

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* 7. Is the panel dialing a DID (local number) or toll free number?

Is the number that the panel is dialing being RCF (Remote Call Forwarded) or pointed to another number (DID)?

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* 8. Is the number that the panel is dialing being RCF (Remote Call Forwarded) or pointed to another number (DID)?

Description of the incident (Include your incident ID number and use your own words to describe what you believe happened)

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* 9. Description of the incident (Include your incident ID number and use your own words to describe what you believe happened)

Communication format being used

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* 10. Communication format being used

Type of Alarm

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* 11. Type of Alarm

Central Station Receiver being used for this account

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* 12. Central Station Receiver being used for this account

If available, email Sur-Gard debug file or any .wav file recording of the event to DACTsurvey@csaaintl.org. Please include your incident ID number in the text of the email so that the file can associated with your questionnaire response. Are you emailing a sound file?

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* 13. If available, email Sur-Gard debug file or any .wav file recording of the event to DACTsurvey@csaaintl.org. Please include your incident ID number in the text of the email so that the file can associated with your questionnaire response. Are you emailing a sound file?

Telephone provider of the central station service on which the incident occurred

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* 14. Telephone provider of the central station service on which the incident occurred

Telephone provider at the customer premise if known

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* 15. Telephone provider at the customer premise if known

Manufacturer of the panel installed

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* 16. Manufacturer of the panel installed

Model number of the panel installed, if known

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* 17. Model number of the panel installed, if known

Your name, company, and email address (so we can contact you with follow up questions)

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* 18. Your name, company, and email address (so we can contact you with follow up questions)

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