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Special Request Form

2. El Paso-Teller County 9-1-1 Special Request Form
   This form is a tool to request feedback regarding a specific call processed utilizing the emergency medical, fire, or police protocols.<br><br>The Quality Assurance Analysts at the El Paso Teller 9-1-1 Authority will review the call and prepare a work product response that will be sent to the call takers Public Safety Answering Point (PSAP) Manager for dissemination. No comments will be returned directly to the call taker or dispatcher without supervisor or manager approval.<br><br>Please provide detailed information to ensure the correct call is reviewed and your specific question is answered.

   This form is a tool to request feedback regarding a specific call processed utilizing the emergency medical, fire, or police protocols.
   
   The Quality Assurance Analysts at the El Paso Teller 9-1-1 Authority will review the call and prepare a work product response that will be sent to the call takers Public Safety Answering Point (PSAP) Manager for dissemination. No comments will be returned directly to the call taker or dispatcher without supervisor or manager approval.
   
   Please provide detailed information to ensure the correct call is reviewed and your specific question is answered.

4. Name*

6. Email Address*

8. Agency*

   1. Colorado Springs
   2. Cripple Creek

   1. El Paso County
   2. Fort Carson

   1. Teller County
   2. Woodland Park

   1. Other

10. Address of Occurrence*

12. Date and Time*
    Date and Time

    Date and Time

14. Call Screen Number

15. Determinant Obtained

17. Protocol Used*

    1. Fire
    2. Medical
    3. Police

19. Comments

Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field