Premise Alert System
Frequently
asked questions
What is the Premise Alert System?
The Premise Alert System provides families
with a uniform method to alert first responders about special needs individuals. It also provides first responders with advance
knowledge, allowing for quick and educated responses during crises, evacuations, and disasters. The form is provided free
of charge to families through DPW and MH/MR Case Managers and can be found at www.papremisealert.com
Police Chief Kevin
McCarthy, Sr. along with Susan F. Rzucidlo, advocate, created this program. It was implemented as a Chester County program
in Nov. 2004. The Premise Alert System is currently on track to become a statewide program.
Who can use it?
Anyone who has a special need, health challenge or disability such as, but not limited
to, Alzheimer’s Disease, Autism, Mental Health Challenges, Mental Retardation, a complex or rare medical condition,
who would like first responders such as police, ambulance and fire department to know of their special needs. HIV/AIDS IS
NOT CONSIDERED A RELEVANT MEDICAL CONDITION FOR THE PURPOSES OF THIS FORM, THE PREMISE ALERT SYSTEM AND PROGRAM. UNDER NO
CIRCUMSTANCES SHOULD INFORMATION RELATED TO AN INDIVIDUALS HIV/AIDS STATUS BE DISCLOSED ON THIS FORM BY ANYONE.
Do I have to give my Foster Care Child’s name on the form?
No, it can be processed
without a name but someone with authorization needs to sign the form.
Who can fill out this form?
*Individuals with special needs can fill it out for themselves.
*Parents of minor children
*Guardians of minor
children
*Current Foster Care Parents (child’s name isn’t required)
*Those with LEGAL guardianship for
another
*Those with the Power of Attorney for another
If you do not have, a legal right to provide this information you should NOT fill out this form or provide this information
Do I have to fill it out?
No, it is VOLUNTARY. You do not have to provide any information you do
not want First Responders to know or use.
How do I use the form?
Fill out the form with as much information as you
would want put into the 911 database, sign it, and then take a copy to your local police department. They will review
it and send a copy to the County 911 center. The information will be put into the system for future use.
What if I live in an area that uses both a municipal police department and a State
Police Department?
If you are in
an area that is served my both municipal and state departments then you need to make two copies and take one to each department.
Take time to talk to an officer about your form.
The form
asks for a recent photograph, what kind of picture is best?
Any picture is better than no picture. What is best is a close up picture of the
persons face, like a passport picture or school picture. It is best if the background is plain. That will be easiest for police
departments to use. The pictures used on the “smile safe picture cards” from school will work. You
can also make an appointment at your police department and an officer will take a digital picture to attach to the form, free
of charge.
Will I receive preferential treatment
by using this form? NO
*Providing this information does not entitle anyone
in a household to preferential treatment. It is simply an
attempt to provide emergency response personnel with information that may be helpful when providing service to residents or
occupants if it can be utilized by responders.
*Providing information in advance may allow first responders to
react and treat in a way that can reduce the possibility of poor outcomes.
How often do I need to fill out a Premise Alert Form?
This form is good for 1 to 2 years depending on the system it is filed in. If you move or need to
make changes in the information just fill out another form and submit it. Any of the systems will automatically use
the new information.
How can I get more copies?
Case Mangers can mail a copy to you or additional copies can
be found on-line at www.papremisealert.com
What if I need help
filling out the form?
Your
case manager, school social worker, guidance counselor, or local advocacy group would be happy to help you fill out the form.
The Premise Alert System and Form is a collaboration between Chief Kevin
McCarthy, Susan F. Rzucidlo, Law Enforcement Entities, disability advocates, parent volunteers, educators, State & County
Officials and other interested parties. It is owned by SPEAK Unlimited Inc. and is protected by copyright laws. It has been
given free of charge to the state of Pennsylvania. PERMISSION: You are permitted and encouraged to reproduce and
distribute this material in hardcopy or electronic form provided that you do NOT alter the wording in any way, you do not
charge a fee beyond the cost of reproduction, you give credit to the original authors, and receive written permission and
approval from Chief Kevin McCarthy or Susan F. Rzucidlo if alterations or changes are being recommended for incorporation.
More information on this program and additional resources can be found at www.papremisealert.com contact
srz@dol.net © 2004-7.
