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NOTE: ALL OF THE INFORMATION BELOW IS REQUIRED.
 

Full name:
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Note: Your name will not be made public or a part of the CLOSE CALL. We just need to know who to ask for if we call you for additional details. ALL RESPONSES AND SUBMISSIONS ARE KEPT TOTALLY CONFidENTIAL WITH THE ONLY INTENT: FIREFIGHTER SAFETY AND LESSONS LEARNED!
ADDITIONAL QUESTION:
Would you like us to COPY this report and ALSO send it to the National Firefighter Near-Miss Reporting System? If so, they have promised us 100% confidentiality and will simply contact you for additional information so your info/data can be used in confidence, for FF Injury research. Rest assured-your info WILL remain confidential as both Captain Graham and Chief Goldfeder are members of the National Near Miss Board. The National Firefighter Near Miss Reporting system is sponsored by the IAFF and the IAFC.
 
 
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