Chenango County Office of Emergency Services

Forms

Select a tab below for the desired form. If you are looking for the Course Pre-Registration form, it is located on our Traning Page.

Chief Authorization Letter

To the Office of Fire Prevention and Control:

This letter is to advise you that the student named below is authorized by myself to attend the course listed. I understand that during this course certain evolutions will be performed that simulate and/or create firefighting conditions. I do not hold the Office of Fire Prevention and Control responsible an/or liable for any malfunction or damage to any equipment supplied by my department. I further state that any equipment supplied is compliant to any standards required by OFPC.

The student has been certified to wear Self Contained Breathing Apparatus. I further state that the student has taken and passed his OSHA compliant Firefighter Physical and is authorized to wear an SCBA and participate in interior and exterior live firefighting operations.

ALL FORM FIELDS ARE REQUIRED.

Fire Department:

Chief's Name:

Date Submitted:

Date Signed:

Chief's Authorization: I certify that this student meets all pre-requisites and is eligible and authorized to attend this course listed.

Course Information

Course Code #:

Course Title:

Student Information

First Name:

Middle Initial:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Email:

Chenango County
Office of Emergency Services

Forms

Chief Authorization Letter

Use & Maintenance Form

Use & Maintenance Form

Chief Authorization Letter

Course Information

Student Information