Chenango County Bureau of Fire
Use and Maintenance Form
Use Details(where applicable)
Type of Use:
Person in Charge:
Organization:
Date of Event: :
Time of Event: From: To:               
Weather: Temperature:
Description of Activity:
Facilities Used:
Equipment Used:
Vehicles Moved: Vehicles Moved By:
 Email Address: * send confirmation of registration
Maintenance Performed (where applicable)
Rooms Cleaned: Yes  No Waste Baskets Emptied: Yes  No
Coffee Area Cleaned: Yes  No Coffee Maker Off: Yes  No
Equipment Put Away: Yes  No Heat Down: Yes  No
Lights Off: Yes  No Doors Locked: Yes  No
Repairs or Corrections Needed:
Was Anyone Injured?* Yes  No
If Yes:   id: Soc. Sec. No.

              *   Also, Fill Out Appropriate Injury Report and Notify Fire Coordinator As Soon As Possible.
Any AdditionalInformation:
First id: Last id:
Title:
I certify that the above information is true to the best of my knowledge, and answered honestly.