Fire department:

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* 1. Fire department:

Fire Chief:

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* 2. Fire Chief:

Address or P.O. Box:

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* 3. Address or P.O. Box:

City:

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* 4. City:

State:

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* 5. State:

ZIP:

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* 6. ZIP:

Email address:

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* 7. Email address:

Fire deaths in 2016:

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* 8. Fire deaths in 2016:

Fire deaths in 2017:

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* 9. Fire deaths in 2017:

What are your department's active fire prevention programs? (Check all that apply)

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* 10. What are your department's active fire prevention programs? (Check all that apply)

Has your department had zero fire deaths or at least a 10 percent reduction in fire deaths from the previous year? (Please choose one or both.)

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* 11. Has your department had zero fire deaths or at least a 10 percent reduction in fire deaths from the previous year? (Please choose one or both.)

Do you have an active fire prevention program in place within your department? Briefly describe your program.

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* 12. Do you have an active fire prevention program in place within your department? Briefly describe your program.

Briefly describe the resources (financial or in-kind) your department committed to fire prevention activities in 2017.

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* 13. Briefly describe the resources (financial or in-kind) your department committed to fire prevention activities in 2017.

Please explain briefly how your fire prevention efforts increased in 2017 over 2016 and how those efforts have made a positive difference in your community.

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* 14. Please explain briefly how your fire prevention efforts increased in 2017 over 2016 and how those efforts have made a positive difference in your community.

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