Muscatine Fire Department Fire/EMS Standby Request

Today's Date*

Date of Event*

Start Time:*

End Time:*

Contact Person*

Contact Phone and email*

Location of Event*

Reason for EMS/Fire Standby*

Is Fire/EMS Standby Required for your Event to Function? *

Yes

No

Staffing Requested*

Engine with 3 Ambulance with 2

EMS ATV with 1

Please list if you are a non profit or governmental agency*

Approve/Deny Officer:_________________________________Date:_____________________
Decision provided to contact:____________________________________