Safe Call

FLPD Safe Call is a program to help first responders identify and get the proper resources and care for at-risk residents who may become separated from their caregivers. The program consists of wearable bracelets and other insignia to alert first responders that they are dealing with an at-risk resident. The unique identifier number on the insignia items is linked to the Fair Lawn Police Department computer-aided dispatch (CAD) system. The at-risk person's data is stored locally, and accessible only to authorized users.

The data you choose to share is up to you. At a minimum, we need the at-risk person's name, address, and contact information of a caregiver. Additional information if you choose to provide it may prove useful in calming the at-risk resident or summoning the proper medical care.

Interested individuals need to complete the form below and the attached Hold Harmless Agreement. A representative from the Fair Lawn Police Department Community Policing Unit will be in touch to schedule a meeting to provide you with the insignia and any additional information.

Thank you for your interest in this program as we endeavor to provide enhanced levels of service for our at-risk residents. Any additional questions can be directed to cp@fairlawnpd.com or by calling the Community Policing Unit at 201-794-5365.

Safe Call Hold Harmless Agreement Send completed forms to cp@fairlawnpd.com

FLPD Project Safe Call Registration

PART 1 - At-Risk Resident Name

Resident First Name

Middle Name

Resident Last Name

Resident Age

Preferred Name / Nickname

Resident Gender

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PART 2 - Contact Information

Resident Home Address

Street

Apartment, Floor, or Suite Number

City

State

Zip Code

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Emergency Contact Email

Does Emergency Contact Live with Resident at Above Address?

Yes

No - If not, enter address below

Emergency Contact Address

Street

Apartment, Floor or Suite Number

City

State

Zip Code

Emergency Contact Business or Work Address (if applicable)

Address Line 1

Address Line 2

City

State

Zip Code

Any Other Pertinent Contact Information

PART 3 - Medical Information

This section is voluntary. Providing this information may assist responding personnel.

Name of Primary Care Doctor

Primary Care Doctor Phone Number

Current Medications

Medical History (to be provided to pre-hospital emergency personnel and hospital emergency department)

List Allergies (if applicable)

Hospital Preference

Type of Disability

Is Resident Verbal?

Yes

Does Resident Understand American Sign Language?

Yes

Primary Language Spoken & Understood

Specific Instructions in Case of Emergency

Calming Mechanisms or Sensory Issues

Safe Call At-Risk Identification Program

FLPD Safe Call Registration

PART 1 - At-Risk Resident Name

PART 2 - Contact Information

PART 3 - Medical Information