PERSONS REQUIRING ASSISTANCE TO EVACUATE

Please complete below fields.

Please be advised that the Fire Department requires us to have a list of residents that might require assistance in the case of an emergency situation in the building.

Your Name

First Last

Email*

Contact Number

Phone Cell

Address*

Street Address Unit City Province Postal Code

You are the*

Owner
Tenant

Please indicate any persons requiring assistance in an emergency situation. We will add this person to our list which will be placed in the Fire Alarm Panel for the Fire Department.

Person Requiring Assistance

Name

Person 1

First Last

Disability

Does this person have trouble walking down the stairs?

Yes
No

Name

Person 2

First Last

Disability

Does this person have trouble walking down the stairs?

Yes
No

Incase of Emergency, please notify,

Please add any additional information you feel would assist us in notifying you in the event of an emergency.

Offices 24h “Live Agent” contact

Vancouver Head Office