Emergency Responder Notification Forms

Cartoon rendering of a police officer, firefighter, and doctor.

Overview

Many counties throughout Pennsylvania have created a form to notify emergency responders that individuals on the autism spectrum, or with other diagnoses or needs, live at a particular address. It is important for emergency responders to be made aware of who lives in the home, any sensitivities than the autistic individual may have, and the types of behavior the responders may witness so they are better prepared to safely handle a potential emergency situation.

Below we have included links to these forms in the counties where they are available. In counties where a form is not available, the website of the county emergency management agency or local public safety office is listed. You can reach out to these offices to learn more about the services they offer and may be able to notify the emergency responders in your area about autistic individuals that may be living at a particular address. Please check back regularly for updates on emergency notification forms.

County Forms

Click a county to find more info

Select a county

Adams County

Allegheny County

Armstrong County

Beaver County

Bedford County

Berks County

Blair County

Bradford County

Bucks County

Butler County

Cambria County

Cameron County

Carbon County

Centre County

Chester County

Clarion County

Clearfield County

Clinton County

Columbia County

Crawford County

Cumberland County

Dauphin County

Delaware County

Elk County

Erie County

Fayette County

Forest County

Franklin County

Fulton County

Greene County

Huntingdon County

Indiana County

Jefferson County

Juniata County

Lackawanna County

Lancaster County

Lawrence County

Lebanon County

Lehigh County

Luzerne County

Lycoming County

McKean County

Mercer County

Mifflin County

Monroe County

Montgomery County

Montour County

Northampton County

Northumberland County

Perry County

Philadelphia County

Pike County

Potter County

Schuylkill County

Snyder County

Somerset County

Sullivan County

Susquehanna County

Tioga County

Union County

Venango County

Warren County

Washington County

Wayne County

Westmoreland County

Wyoming County

York County

Name	Description	Type	File
Social Story- Premise History Form for Emergencies	Social story that explains how premise history forms can be useful in emergency situations.	pdf	Download file: Social Story- Premise History Form for Emergencies
The Importance of Completing a Premise History Form	This resource provides information on the importance of completing a Premise History Form and what should be included to keep you or a loved one in your family safe in the event of an emergency.	pdf	Download file: The Importance of Completing a Premise History Form

ASERT Does Not Offer Crisis Services