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Fire & Life Safety Service Request

Fire & Life Safety Service Request

Fire & Life Safety Service Request

Today's Date:*
MM slash DD slash YYYY
Name of Person Completing Form:*
First Last
Email Address:*
Phone Number*
Company/Affiliation:*
Facility Upon Which Service is Requested
Search for a Building*
Facility Manager Name:
Facility Manager Email:
Facility Manager Phone Number:
Services
Service Requested:*
- Report a concern
- Request to speak with a Fire & Life Safety representative
- Request an additional fire extinguisher
- Request a new fire extinguisher due to discharge or damage
- Request fire extinguisher training
- Request a site visit
- Request information about AED's
- Request information about Shower/Eyewash units
- Request an update to evacuation maps
- Request information about OEP's (Occupancy Emergency Plan)
- Report a fire, smoke, or explosion related incident
Description of Incident:
Method of Communication:*
- Email
- Phone Call
Phone
This field is for validation purposes and should be left unchanged.

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University of Wisconsin-Madison
Environment, Health & Safety
21 North Park, Rm. 7259
Madison, WI 53715
Email: EHS@wisc.edu
Phone: 608-265-5000

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