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Special Request Form

El Paso Teller 911
Special Request Form

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 911 Authority will review the call and prepare a “work product” response that will be sent to the call takers 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.

Name: *
E-mail: *
Agency:*
Address of Occurrence:*
Date:*
 /   / 
Time: *
 : 
Call Screen #:
Determinant Obtained:
Protocol Used: *
Comments:
Word Verification: