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					                                         NC Fire & Life Safety Education Report
2011
  Department/Agency Name:                                                                                      Person Reporting:
              County Name:
             FD / Agency ID:

Number of Programs:            Jan       Feb       Mar       Apr       May       Jun       Jul       Aug        Sep       Oct       Nov       Dec       Totals
Bicycle Safety                                                                                                                                                   0
Buckle Bear                                                                                                                                                      0
Burn Prevention                                                                                                                                                  0
Calling 9-1-1 (or Emerg. #)                                                                                                                                      0
C.E.R.T.                                                                                                                                                         0
Child Safety Seat                                                                                                                                                0
Disaster Preparedness                                                                                                                                            0
Display                                                                                                                                                          0
Extinguisher                                                                                                                                                     0
Falls                                                                                                                                                            0
Farm Safety                                                                                                                                                      0
Fire/Evacuation Drills                                                                                                                                           0
Firearms                                                                                                                                                         0
First Aid / CPR                                                                                                                                                  0
General Fire Safety                                                                                                                                              0
Juvenile Fire Setters                                                                                                                                            0
Operation Life Saver                                                                                                                                             0
Poison Prevention                                                                                                                                                0
Public Relations                                                                                                                                                 0
Remembering When                                                                                                                                                 0
Residential Sprinklers                                                                                                                                           0
Risk Watch                                                                                                                                                       0
Special Event                                                                                                                                                    0
Start Safe                                                                                                                                                       0
Station Tour                                                                                                                                                     0
Vehicle Safety (VIP, etc)                                                                                                                                        0
Water Safety                                                                                                                                                     0
Other (robots, etc.)                                                                                                                                             0
Total Programs                       0         0         0         0         0         0         0         0          0         0         0         0            0

Total Hours of Presentation                                                                                                                                      0

Number of Participants:
0-4 years (preschool)                                                                                                                                            0
5-10 years (elementary)                                                                                                                                          0
2011
  Department/Agency Name:                                                                                        Person Reporting:
                County Name:
               FD / Agency ID:
11-13 years (middle school)                                                                                                                                        0
14-18 years (high school)                                                                                                                                          0
Adults 19-61                                                                                                                                                       0
Seniors 62+                                                                                                                                                        0
Total Participants                     0         0         0         0         0         0         0         0          0         0         0         0            0

                                 Jan       Feb       Mar       Apr       May       Jun       Jul       Aug        Sep       Oct       Nov       Dec       Totals
Number of Organizations:
Business                                                                                                                                                           0
Civic groups                                                                                                                                                       0
Daycare                                                                                                                                                            0
Healthcare                                                                                                                                                         0
Industrial                                                                                                                                                         0
Juvenile fire setters                                                                                                                                              0
Schools                                                                                                                                                            0
Seniors Groups                                                                                                                                                     0
Special Interest                                                                                                                                                   0
Youth groups                                                                                                                                                       0
Other                                                                                                                                                              0
Total Organizations                    0         0         0         0         0         0         0         0          0         0         0         0            0

Detectors:
Smoke detectors issued                                                                                                                                             0
Hearing impaired alarms                                                                                                                                            0
CO detectors issued                                                                                                                                                0
Batteries issued                                                                                                                                                   0

Car Seats:
Number of Seats Installed                                                                                                                                          0
Number of Seats Issued                                                                                                                                             0

Helmets:
Bike Helmets Issued                                                                                                                                                0

                                                                     Please mark selection with an X
Did a program save a life or reduce an injury?                  Yes                  No
Details:
2011
 Department/Agency Name:                                                               Person Reporting:
             County Name:
            FD / Agency ID:




Additional Comments:




            For questions, comments or when report is complete; email this form and any pictures you may have to:
                                           Terri Byers - tbyers@hickorync.gov
                                                            OR
                                          Thomas Raper - traper@hickorync.gov

				
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