911 Disability Indicator Form
The disability indicator program is voluntary for both the community and it's residents and was created by a group of several different organizations representing the mobility, hearing, speech and sight impaired communities.
The information provided on the disability indicator form enables a special code to appear on the 911 call takers screen which alerts the call taker that a person residing at that address may require special assistance during an emergency.
When your 911 call is answered by the Metro North Regional Emergency Communication Center, the 911 system automatically displays your name, address and telephone number on the dispatcher's screen. At your request, codes will be displayed 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 communicate with the caller and provide useful information to responding public safety personnel.
This standardized form created to encourage participation from all persons with disabilities. As you are aware, there are an extensive range of disabilities and medical conditions. The disability indicator categories listed on the form may be considered too broad for some; when you consider the extensive range of disabilities. However, information requested on the form must remain sensitive to those who may not wish to provide detailed information.
Always remember information on the disability indicator form is confidential. The information you provide will only appear at the dispatcher's location when a 911 call originates from your address.
The disability indicator form can be downloaded from this website.
When filling out the form be sure to:
1. Give your telephone number, name and address
2. Check the box or boxes that best describe your disability
3. Sign and date the form.
4. Return the form to:
Attn: Richard Swartz - Director of Communications
Metro North Regional Emergency Communication Center
400 Revere Beach Parkway
Revere, MA 02151
Please refer any questions to:
Richard Swartz - Director of Communications
781-629-9260 or firstname.lastname@example.org
Annually, Verizon will send the Communication Supervisor a current listing of those persons in their community who are enrolled in the disability indicator program for updating. Verizon enters the new information into the 911 database. A new Disability Indicator Form should be submitted for the following:
1. A person moves or no longer resides at that address
2. The apartment number changes
3. The telephone number changes
4. To add or delete a disability
Remember to review the lists carefully to maintain accurate records which will ensure the proper response in the event of an emergency.
Go to Disability Indicator Form