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9-1-1 Recognition Program Instructions

Illinois APCO and NENA Chapters

9-1-1 Recognition Award Program

2014

 

Purpose:

The primary purpose of the Illinois APCO and NENA 9-1-1 Recognition Award program is to recognize and reward a person who demonstrated knowledge of the proper use of 9-1-1 by performing some heroic action during the course of the emergency/call and to promote public education and awareness of 9-1-1.  Heroes must meet the following criteria developed by the Illinois APCO and NENA Public Education Committee.  If these criteria are met, the person will be recognized by the committee, receiving an award as well as publicized over various social media outlets sponsored by the committee.

Criteria:

  1. Heroic event must be ongoing or have occurred during the period January 1, 2013 to December 31, 2013.
  2. If the caller is a child, the 9-1-1 call must be self-initiated by the child and/or either the child followed pre-arrival instructions, or performed some other heroic act.
  3. The person must have performed some heroic action in the course of the emergency that contributed to:
  • Saving a life
  • Significantly reducing property loss
  • Apprehending a criminal and or stopping a crime
  1. The agency submitting the nomination should complete the recognition nomination form including a brief summary of the incident.  If possible, an audio recording of the 9-1-1 call should accompany the 9-1-1 Recognition Nomination form. 

Nomination forms must be received by April 7th, 2014 to be considered.  The award is to be presented during the month of April in recognition of National 9-1-1 Education Month.   


 


911 Recognition Program Nomination Form

9-1-1 Recognition Nomination Form

 

INCIDENT INFORMATION

Please be specific with your description

Date of 9-1-1 CallTime of 9-1-1 Call:

Who was assisted or saved: (Name of family members, neighbors or others involved in the incident)        

Where: (where the event took place)

Other: (miscellaneous facts)

RECIPIENT INFORMATION

Recipient Name: Age: Grade: Gender: ? Male    ? Female

Parent or Guardian’s Name(s) (if recipient is child):                    E-mail:

Address:

City: State: Zip:

Daytime Phone:   | Evening Phone:   | Cellular:  

Name of Child’s School:                                                                                    What Grade:   

City: State: Zip:

Has the nominee received any education about 9-1-1?  ?Yes   ?No

CALL TAKER OR DISPATCHER INFORMATION

Call Taker or Dispatcher Name: ?Male ?Female | No. yrs. working as a Call Taker/Dispatcher: :AATELECOMMUNICATOR _____ |

Call Taker or Dispatcher Name: ?Male ?Female | No. yrs. working as a Call taker/Dispatcher:

Call Taker or Dispatcher Email:  

Any Other Information About the Call Taker or Dispatcher?   

PUBLIC SAFETY ANSWERING POINT (PSAP) INFORMATION

9-1-1 Communication Center Name:

Address:

City: State:            Zip:

Phone:   Facsimile: 

Contact Person (for questions): E-mail:

Direct Dial:   ext. / Facsimile:

Is the 9-1-1 Call or Dispatch Available for a Media Event? ? Yes please send CD, Wav file or tape of call     ? No

NOMINATOR INFORMATION

Name of Nominator:                                                                                      Email:

Nominator’s Employer:                                                                                 Position:

Nominator’s Phone: 

FOR QUESTIONS, PLEASE CONTACT Wendy Mann at  847-599-7000

 

 

 

 

 

 

 

 

 

Signature:___________________________________________

Date:___________________________________________