SPECIAL EVENT NOTIFICATION / REQUEST FORM UCONN Fire Department Special Event Notification or Request Select One* I am requesting authorization to conduct an event or I am notifying the fire department of an event I am conducting which does not require fire department staffing. I have received authorization to conduct an event and wish to schedule fire department personnel Requesting / Notifying Party InformationName:* First Last Title: Phone:*If you are the event primary contact, please note phone number where you can be reached on day of event (i.e. cell).Email:* Event Primary Contact Different than Above?* Yes No Event Primary ContactName:* First Last Title: Phone:*If you are the event primary contact, please note phone number where you can be reached on day of event (i.e. cell).Email:* Event InformationDate:* MM slash DD slash YYYY Time Frame (Start Time - End Time):* Total Hours:* Location:* Add More Dates or Times?* Yes No If multiple dates, please list all dates, associated times, and total hours for each date:*Will there be (check any/all that apply): Tents Electricity Used to Outside Locations Electricity Indoors using Extension Cords and/or Power Strips Heat Sources Pyrotechnics Large Crowds Other Fire Safety or Emergency Medical Considerations Type/Purpose/Description of event:If this event has been conducted in the past, please describe short history of this event. Include any previous fire department requirements imposed or discussed, any past history of excessive alcohol or drug consumption, fire incidents or emergency medical services:Billing InformationIf you have a quote, please enter the quote number here: Will the extra duty staff be paid for by a University Department?* Yes No Name of Department* KFS Number* Is the administrative contact for billing the same as the requesting party? Yes No Name of Administrative Contact Person for Billing Phone Number of Administrative Contact Email of Administrative Contact Payor Name Attn: Payor Street Address Payor City Payor State Payor Zip Code FD CONTACT INFORMATIONPlease take note and pass along the contact information for the fire department which you will view on the confirmation page and receive in the confirmation email. Billing AcknowledgementPlease read and check box indicating approval. I understand that I am authorized to make this request and that in some situations; this event cannot be conducted without the proper authorization from the University Fire Marshal or Fire Chief. If standby personnel are required for this event, I agree that I will be notified of the expected expense and I will be responsible for the subsequent cost. Authorization from the Fire Department does not constitute “University-wide” approval and I understand that it is my responsibility to consult or obtain any other departments/persons authorizations prior to proceeding.You must read and agree to the above, in order for you to continue* I Agree NameThis field is for validation purposes and should be left unchanged.
