New Jersey Department of Community Affairs - Division of Fire Safety Local Enforcing Agency Survey Form

LEA Number: *

LEA Name: *

Reporting Year: *

Appointed Fire Official Name: *

Certification Number: *

Expiration: *

Fire Prevention Office Address: *

Fire Prevention Office City: *

State *

Zip Code *

Phone Number *

EMERGENCY CELL PHONE NUMBER *

Fax Number: *

Fire Official Email Address: *

Fire Official Web Page Address: *

Fire Inspectors Currently Working for Municipality

Fire Inspector Name: *

+-

Certification Number: *

+-

Expiration Date: *

+-

Fire Inspectors That No Longer Work for Municipality

Fire Inspector Name:

+-

Certification Number:

+-

Expiration Date:

+-

Agency Responsible for Smoke/CO Detector Compliance

Agency Name: *

Street Address *

City *

State *

Zip Code *

Phone Number *

Agency Responsible for Non-Life Hazard Use Hotels and Multiple Dwelling Inspections

First Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Juvenile Fire Setters Program

Do you have this program? *

Yes

No

Program Manager: *

Daytime Telephone Number: *

Email Address *