Allegany County Emergency Services Chief's Authorization First Responder ID Form

Chief's Authorization Form

Form for New, Updated or Replacement First Responder ID
Each Allegany County First Responder will receive two identification (ID) tags, with colors signifying the responder's specific qualifications:

- Red: Interior Firefighter
- Orange: Hazardous Materials (Hazmat)
- Yellow: Exterior Firefighter
- White: Fire Police, Auxiliary, New Member & Junior
- Blue: Emergency Medical Services only
- White: Medical Reserve Corps (MRC) & Community Emergency Response Team (CERT)

There are three scenarios in which first responder ID tags may be issued:

1. New Member: For individuals who have never received ID tags.
New members should first contact their Fire Chief for guidance on obtaining tags.

2. Updated Tags: Issued for changes in name, fire department (FD), training, or qualifications.

3. Replacement Tags: For lost, stolen, or damaged tags that require replacement.

Please complete the form below to request new or replacement ID tags.
Choose Type of ID requested *
Member Name*

First NameLast Name
DOB*

MonthDayYear
Date
Department/Agency *
Please list
Department Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Qualifications: (Select all that apply)

Interior FFExterior FFHazmatAuxiliary- member of FD auxiliaryFire Police- NYS certified Fire Police * Must show current NYS Fire Police Certification cardMember (No Certifications)Junior Member
EMS Qualifications: (Select all the apply)

CFREMTAEMTCritical CareParamedicOther
Please list Other Qualifications:
The Fire Chief must collect and securely destroy all ID cards from firefighters who are either suspended from the department or have had changes in credentialing status, to prevent misuse of IDs.

By signing below, the Fire Chief (or EMS Administrator for independent agencies) certifies that the individual listed above is an active member of the fire department or EMS agency and has completed the training indicated above.
Chief's Name*

First NameLast Name
Cheif's Signature*

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Chief's Authorization Form