Premise Alert Question & Answers
What is the Premise Alert System?
The Premise Alert System provides families with a uniform method to alert first responders to the special needs of
individuals in their community. By providing first responders with advance knowledge, it allows for quick and educated
responses during crises, evacuations, and disasters. The service is provided free of charge, and the enrollment form and can
be found at www.PaPremiseAlert.com.
Created in 2004 by East Earl Township Police Chief Kevin McCarthy, Sr., and Susan F. Rzucidlo, Director of SPEAK
Unlimited, Inc., the Premise Alert System was first implemented in Chester County, Pennsylvania. McCarthy and
Rzucidlo then gifted the system to the state of Pennsylvania in 2008. It has been replicated in Illinois and Wisconsin
and is in use by communities and families across the nation and in Canada.
Who can use Premise Alert?
The system is designed for anyone with a special need, health challenge, or disability — such as, but not limited to,
Alzheimer’s, autism, mental health challenges, mental retardation, or a complex or rare medical condition — who
would like first responders such as police, ambulance, and fire department personnel to know of their special needs.
HIV/AIDS IS NOT CONSIDERED A RELEVANT MEDICAL CONDITION FOR THE PURPOSES OF THE
PREMISE ALERT SYSTEM. UNDER NO CIRCUMSTANCES SHOULD INFORMATION RELATED TO AN
INDIVIDUAL’S HIV/AIDS STATUS BE DISCLOSED BY ANYONE ON THIS FORM.
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, where the information
will be put into the system for future use. Only provide the information you are comfortable disclosing. Names do not
need to be included in order to submit the form.
Who can fill out this form?
The Premise Alert form can be completed by:
• Individuals with special needs, who can fill it out for themselves
• Parents or guardians of minor children
• Current foster care parents (the child’s name is not required)
• Those with legal guardianship for another
• Those with power of attorney for another
If you do not have a legal right to provide this information, you should NOT fill out this form.
Am I required to participate?
The Premise Alert System is VOLUNTARY. You do not have to provide any information you do not
want first responders to know or use.
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.
What if I live in an area that uses both a municipal police department and
the state police department?
If you are in an area that is served by both municipal and state police departments, you need to make two copies
and take one to each department. If possible, take time to talk to an officer about the information provided
on the form.
The form asks for a recent photograph. What kind of picture is best?
A close-up picture with a plain background, like a passport or school photo, will be easiest for police departments
to use. The pictures used on the “smile safe picture cards” from school will work, or you can ask to make an
appointment at your police department and have an officer take a digital picture free of charge.
Will I get preferential treatment as a result of Premise Alert?
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 to them when providing
service to residents or occupants in special circumstances.
How often do I need to fill out a Premise Alert form?
The form is good for one to two years, depending on the system used in your county or state. If you move or need
to make changes to your information, just fill out another form and submit it. Most computer-aided systems will
drop unused or outdated information. It is important to keep your information up to date.
How can I get more copies?
You can find the form online at www.PaPremiseAlert.com. In Pennsylvania, your state representative or senator
can provide you with a copy as well.
What if I need help filling out the form?
A case manager, school social worker, guidance counselor, or local advocacy group would be happy to help you, or
you can contact SPEAK Unlimited, Inc., for additional information.
The Premise Alert System is a collaboration between Chief Kevin McCarthy, Susan F. Rzucidlo, law enforcement entities, disability advocates, parent volunteers, educators, state and 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 hard-copy 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, and you give credit to the original authors. You must receive written permission and approval from Chief Kevin McCarthy or Susan F. Rzucidlo if alterations or changes are being recommended for incorporation. © 2004-11 SPEAK Unlimited Inc.
www.PaPremiseAlert.com.
