Business Emergency Contact & Access Information

Business Emergency Contact & Access Information

Please provide your business and emergency access details for after-hours contact and site entry.
Business Name
Business Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Point of Contact
After-Hours Keyholders
Keyholder Calling Order (if you have multiple keyholders, please list them in the order you wish for them to be contact in case of an emergency)
Alarm Company Name
Alarm Company Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gate Code
Gate Code Location (where to enter/use code)
Door Code
Door Code Location (where to enter/use code)
Lock Box/Knox Box Location
Please note business access information (entrances, roof access, elevators)
Hazards at the Site (e.g., chemicals, animals, fuel storage, batteries, solar, kitchens)
Does your business have video cameras?
Does your business have a floor plan or site map?
Does your business have a fire hydrant/FDC?
If yes, where?
Does your business have AEDs, oxygen storage, and/or mobility-impaired occupants?
If yes, which ones?
Could people be inside of your business after hours?
Additional Comments or Instructions
*It is the responsibility of your business to notify the Suffolk Police Department of any changes to Keyholders, Phone Numbers, Door Codes or other items listed on this form*
Should be Empty:

*It is the responsibility of your business to notify the Suffolk Police Department of any changes to Keyholders, Phone Numbers, Door Codes or other items listed on this form*