If you have a disability and would like the Merrimac Police and Fire Departments be made aware of your disability, please fill out the following form and return it to the Merrimac Police Department. This information is confidential and will ONLY appear at the dispatcher’s location when a 9-1-1 call originates from your address.
PLEASE NOTE: IT IS IMPORTANT TO SUBMIT A NEW DISABILITY INDICATOR FORM UPON CHANGE OF SERVICE PROVIDER, TELEPHONE NUMBER, OR ADDRESS.
When your 9-1-1 call is answered at your local Public Safety Answering Point, the 9-1-1 system automatically displays your name, address and telephone number on the dispatcher’s screen. At your request, codes will be displayed on the dispatcher’s screen that will identify the disability indicators that have been reported for you or someone living with you at your address.
These codes will help the dispatcher at the 9-1-1 Public Safety Answering Point to communicate with the caller and provide useful information to your responding public safety agency. The information is confidential and will only appear at the dispatcher’s location when a 9-1-1 call originates from your address.
The information you provide for input to the 9-1-1 system will remain until you request a change or make a request to have it removed. It is your responsibility to notify your 9-1-1 Municipal Coordinator when there is a change in the information described on this form. When there is a change, complete another form and send it to your 9-1-1 Municipal Coordinator.
If the disability indicator form is not completed properly, the information will not be entered into the 9-1-1 system.
Click here to access a printable version of the form which may be dropped off in person or emailed to msayers@merrimacpolice.org.