Certificate of Valor - DOC

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					                              APPLICATION PROCEDURES FOR


The Awards are available annually for presentation to Volunteer Firefighters by the New Jersey State
Fire Chiefs' Association, in cooperation with the VFIS of New Jersey.

1.   The Valor Award may be made to any Volunteer Firefighter in the State of New Jersey for an act
     of valor while performing duty as a Volunteer Firefighter.

2.   The Valor Award period shall be from January 1 through December 31. The application shall be
     presented by January 20 to the Association and forwarded to the Valor Committee no later than
     February 10.
3.   The nomination for a Valor Award shall be submitted on the Application Form furnished by the
     New Jersey State Fire Chiefs' Association. It must be completed and must furnish all special
     information requested. It must be certified by a Chief Officer of the Department or the Incident
     Commander. There shall be only one name per Application. Upon completion of the Application it
     must be returned to the Secretary for processing.

4.   Supporting evidence should be submitted with the application. This can include, but not be limited
     to: statements of Fire Service and or Civilian witnesses, media accounts and pictures,
     environmental conditions, time, fire and smoke condition, and the conditions of victims at the time
     of the incident. The more details submitted will help the Committee to make a more accurate
     evaluation. Emphasis should be on the Act of Valor, not merely good execution of assigned duties.

5.   The completed application shall be submitted: Jere E. Cole, Jr., Secretary
                                                   New Jersey State Fire Chiefs’ Association
                                                   54 Woodledge Court
                                                   Rockaway, NJ 07866-2245

      A Valor Award Committee member may contact the person making the nomination to confirm that
      the information is valid and obtain additional details.
6.   There may be two Valor Awards each year. If so, one would first place and the other one would be

                First:        A $100.00 Savings Bond, Gold Medal and a Commemorative Plaque

                Second:       A $50.00 Savings Bond, Silver Medal and a Commemorative Plaque

7.   The Committee may present a Certificate of Recognition to the Valor Award applicants who did
     not win the First or Second place award.

8.   The Committee may present a Unit Citation for a group Act of Valor.

9.   The recipients of the Valor Awards are invited to attend the Annual Meeting of the New Jersey
     State Fire Chiefs' Association in order to receive the award. If the recipient is unable to attend the
     Annual Meeting, the award will be made at a Regular Meeting of the Executive Board. In the event
     the recipient cannot attend either meeting then the Officers of the Association will make alternate
     arrangements for the presentation.

Revised, October 2, 2006
                                            APPLICATION FOR
                                            ( serving as a Volunteer)
                      New Jersey State Fire Chief’s Association
                                          ( Type or Print Application )

1. Date of Meritorious Act                                         20        Time

2. Nominee’s Name                                                            Rank

3. Home Address: Street                                             City

4. Fire Department or Company                                                           Years of Service

5. Reason for Meritorious Act: Fire         Drowning      Cliff         Sewer       Explosion       Auto        Other


6. Location of Incident

7. Weather:    Fair        Snow       Fog       Rain       Other           Temperature
        ( If Meritorious Act was related to a structural Fire, Complete 8 thru 12 )
8. Type of Construction

9. Height of Construction ( or Depth )

10. Type of Occupancy, Dwelling             Apartment     Public Building            School        Other ( explain )

11. Location and extent of fire upon arrival

12. Describe Smoke Condition

13. Unusual features of involved occupancy: Old Age Home                        Panic          Congested

Highly Flammable            Other

14. Persons rescued:
Name                                Age     Gender      Physical Condition
                                                         (Normal, Disabled, Conscious, Panic-stricken, Other)

Revised, October 2, 2006
If more space is needed use a second sheet.

17. Describe where victim was found

18. Describe the injuries to the victim

19. Describe the injuries to the rescuer

20. Was SCBA used?                            Yes            No

21 Was protective gear used?                  Yes            No

22. Was protective Stream used?               Yes            No

23. Was additional help present?              Yes            No

24. Was rescue made with assistance?          Yes            No               If yes, describe

25. Give details of Meritorious Act.

                                 Attach all supporting information, incident report, witnesses, photos etc.

The undersigned hereby states that the information contained is substantially correct to the best of their

Signature of Submitter                           Signature of Fire Officer

Rank of submitter                                Rank of Fire Officer

Fire Department                                                       Phone

Fire Department Address

Signatures of Approval of the Valor Awards Committee;
                                                                        Mail Completed Application to:

                                                                        Jere E. Cole, Jr., Secretary
                                                                        New Jersey State Fire Chiefs’ Association
                                                                        54 Woodledge Court
Date of Approval                                                        Rockaway, NJ 07866-2245

Revised, October 2, 2006

Description: Certificate of Valor document sample