What
is the “Milford Disability Indicator Form”?
It is a voluntary
form for both Milford and it's residents. The disability indicator form was
created by a group of several different Massachusetts organizations representing
the mobility, hearing, speech and sight impaired community. The information provided on the disability
indicator form enables a special code to appear on the 911 call taker’s screen
which alerts the call taker that a person residing at that Milford (Massachusetts)
address may require special assistance during an emergency.
It is a standardized Confidential form created to encourage
participation by all persons with disabilities. We are all aware that there
is an extensive range of disabilities and medical conditions, and the disability
categories listed on the form may be considered too broad for some. Respecting
that, you still must confine your response to the categories presented on
the form.
It is your responsibility to notify the Milford 9-1-1 Municipal
Coordinator when there is a change in the information described on this form.
When there is a change, complete another form and send it to the Milford
9-1-1 Municipal Coordinator.
Information and Instructions
DISABILITY INDICATOR
FORM for Milford
(MASS) Residents ONLY!
You must
complete this form if you want the Milford (Massachusetts) Police department,
Fire department, or other emergency agency to know about you when you call
9-1-1 in an emergency.
When your
9-1-1 call is answered at the Milford (Massachusetts) Public Safety Answering
Point, the 9-1-1 system automatically displays your name, address and telephone
number on the dispatcher’s screen.
At your request,
codes will be displayed on the dispatcher’s screen that will identify the
disability indicators that have been reported for you or someone living with
you at your address. These codes will help the dispatcher at the 9-1-1 Public
Safety Answering Point to communicate with the caller and provide useful information
to your responding public safety agency.
The information
is confidential and will only appear at the dispatcher’s location
when a 9-1-1 call originates from your address.
The information
you provide for input to the 9-1-1 system will remain until you request a
change or make a request to have it removed.
It is your
responsibility to notify the Milford 9-1-1 Municipal Coordinator when there
is a change in the information described on this form. IMPORTANT:
When there is a change, complete another form and send it to the Milford
9-1-1 Municipal Coordinator.
If
the disability indicator form is not completed properly, the information will
not be entered into the 9-1-1 system.
When filling
out the form, be sure to:
1. Give your
Milford (Massachusetts) 10 digit telephone number, name, and address
2. Check
the box or boxes,
3. Sign and
date the form,
4. Submit
the form to your Milford (Massachusetts) 9-1-1 Municipal Coordinator for processing
by mailing it to:
Louis J.
Celozzi, E911 Coordinator
Milford Town
Hall
52 Main Street
Milford,
MA 01757
Any questions
should be referred to the Milford 9-1-1 Municipal Coordinator:
Mr. Louis
J. Celozzi at telephone (508) 634-2303, FAX (508) 634-2324.