NFPA Rural Fire & Life Safety Symposium Interest Survey

Tell us about you and your fire department

NFPA is hosting a fire and life safety symposium on May 12 & 13, 2017 in the Boston area to bring together representatives from rural fire departments across North America. The purpose is to assess fire and life safety education needs, gain a clear picture of fire department challenges related to prevention, and receive input about how we can better serve rural and volunteer fire departments in their public education, prevention, and Community Risk Reduction efforts. Your input on this survey will help us invite the right mix of rural firefighters. For more information about the symposium, go to www.nfpa.org/rural or reach out to Karen Berard-Reed at kbreed@nfpa.org.

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* 1. What is your name?

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* 2. What is your email address?

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* 3. What is your fire department rank?

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* 4. Provide the following information about your fire department:

Name of the department:

Street address:

Community:

State/Province:

Zip Code / Postal Code

Name of current Chief:

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* 5. Which best describes your fire department?

Paid

Combination Paid & Volunteer

All volunteer

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* 6. How many people live in the service area of your fire department?

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* 7. How many square miles does your fire department service area cover?

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* 8. Which of the following activities do you fulfill in your fire department role? (Check all that apply)

Assist on EMS runs

Collect &/or analyze data

Conduct community outreach

Conduct Inspections

Educate residents about home fire safety

Educate residents about wild fire safety

Install smoke alarms for residents

Lead the department

Raise funds / write grants

Recruit firefighters

Suppress fires

Train firefighters

Other (please specify)

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* 9. Think about your department's interest and activity around fire safety education in the community. Select the statement that best describes your fire department.

Fire safety education is important. Educational outreach activities take place frequently.

Fire safety education is important. Educational outreach activities take place occasionally.

Fire safety education is important. Educational outreach activities rarely take place.

Fire safety education is not a priority to our department at this time.

Other (please specify)

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* 10. What challenges face your department that make it difficult to protect people from fire?

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* 11. Up to 60 rural fire department members will be selected to attend the symposium on May 12 and 13. NFPA will cover travel expenses for each participant. If you are selected to attend the symposium, can you:

	Definitely	No	Maybe
Travel to Boston on May 11?	Travel to Boston on May 11? Definitely	Travel to Boston on May 11? No	Travel to Boston on May 11? Maybe
Attend the symposium for a full day on May 12 and a half day on May 13?	Attend the symposium for a full day on May 12 and a half day on May 13? Definitely	Attend the symposium for a full day on May 12 and a half day on May 13? No	Attend the symposium for a full day on May 12 and a half day on May 13? Maybe
Provide a letter of support from the Chief of your fire department?	Provide a letter of support from the Chief of your fire department? Definitely	Provide a letter of support from the Chief of your fire department? No	Provide a letter of support from the Chief of your fire department? Maybe

If you indicated "maybe", please explain:

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* 12. If you are selected to attend the symposium, you will be notified by March 20, 2017. Please provide the following contact information so we can reach you:

Primary email address (same as above)

Secondary email address (optional)

Phone number