Business Information
This provides our First Responders with a brief summary of your business. You may be contacted by the Fire Department to do a brief walk-through and yearly information update.
Business Name
*
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Email
*
example@example.com
Jurisdiction
Please Select
City of Cleveland
City of Helen
Unincorporated County
Physical 911 Street Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your mailing address same as your physical address?
*
Yes
No
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this a home-based business?
*
Yes
No
Is this a Short Term Rental?
*
Yes
No
Hours of Operation
*
Total Number of Employees
Daytime Employees
Night Employees
Power Company
Please Select
Habersham EMC
Georgia Power
Water
Private
Public
Are there hazardous materials onsite?
*
Yes
No
Are MSDS Sheets available onsite?
*
Yes
No
Are there any other Special Hazards?
Yes
No
Where are the Hazardous Materials located?
Please list Hazardous Materials by brand and trade name:
Where are the MSDS Sheets located?
Please list MSDS Sheets by brand and trade name:
Please describe other special hazards:
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Emergency Contact Information
Primary Contact
*
First Name
Last Name
Primary Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact #2
First Name
Last Name
Emergency Contact #2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact #3
First Name
Last Name
Emergency Contact #3 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact #4
First Name
Last Name
Emergency Contact #4 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: