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Premise History Form for Emergencies Social Story

Overview

This social story explains how filling out a premise history form can be helpful in emergency situations.

A cell phone calling 9-1-1, ambulance, and police car.

If there is an emergency, I may need to call 911. They can send police, fire department, or an ambulance to me if I need it.

A man holding a cell phone up to his ear and a 9-1-1 operator at his desk.

It is important for 911 staff to know as much as possible about me, my family and the situation.

A man talking on the phone saying,

I may be scared or anxious and forget important information to share when I call 911.

Image of a form and pencil

I can fill out a Premise History Form before I have an emergency.

Image of a cell phone calling the police and an image of an officer.

I can contact my local police or county dispatch and ask for a Premise History Form.

A computer screen

If my county doesn’t have their own form, I can download a Premise History Form online.

A form that says Joe Smith, 123 River Drive, 24 years old.

I can include my name, address, and age in the Premise History Form.

A form that says Joe Smith, 123 River Drive, age 24, autism diagnosis.

I can include information about my autism diagnosis.

Images of headphones, an iPad, and a fidget spinner.

I can also share how I communicate, any sensory sensitivities, and what keeps me calm.

Images of a fire fighter, police officer, and paramedic

The information helps police, the fire department, or other first responders know how to help me when there is an emergency.

Images of a police station and mailbox

Once I complete the Premise History Form, I can mail or take it to my local police department or county dispatch center, so they have my information.

Image of a calendar

I need to keep my Premise History Form updated. Some counties ask for new forms every few years. Having this information will help keep me safe in an emergency.

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This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.