Antioch Volunteer Fire Department

5430 GA HWY 219 - Fortson, GA 31808 - 706.576.5559

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Community Survey
Please complete the information below,
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Antioch Volunteer Fire Department
5430 GA HWY 219
Fortson, GA 31808
706.576.5559

What Is The Purpose Of This Survey

In an effort to improve the fire protection in our community, we are asking residents to respond to this survey as soon as possible. The goal is to improve our emergency response ability and reduce potential loss of life and property. We are called on by Harris County 911 center for both fire and medical emergencies, and this information will allow Antioch Volunteer Fire department to better plan its response to any situation.

We are also asking that every household and business check their smoke detectors, fire extinguishers and to prepare an escape plan for your family or employees to use in the event of fire. If you find that you do not have a working smoke detector or fire extinguisher and need help installing or replacing one, please let us know. If you have difficulty checking these devices or need assistance with an escape plan, we can assist with this as well.

We have a limited supply of equipment that we will provide free of charge, and assist with installation if necessary. If you are in need of equipment or assistance you may complete and submit this survey, or contact us at 706-576-5559 or info@antiochvfd.org. Additional contacts are Greg Taylor, 706-327-7655 or Clark Webster, 706-571-9916.

You can locate information on smoke detectors by clicking here, and information on escape planning by clicking here.

Antioch Volunteer Fire Department is a volunteer organization which relies on the residents of our area for membership and support. We welcome everyone at our general business meeting held the first Monday of each month at 8:00 pm at Station 1 (located at the intersection of Lick Skillet Rd. and GA HWY 219/River Rd.). Here you can meet our current members, ask questions, and complete a volunteer application. Interested volunteers are also welcomed at any scheduled training. Click here for a copy of our meeting and training schedule.

Tell Us About You

Property owner name:

Property address: City: State: ZIP:

Home phone: Mobile phone: Email address :

Tell Us About Your Home/Business

What is your property type?
Residential Business Other

Do you have a smoke detector? Yes No

Have you tested your smoke detector in the last 12 months? Yes, I have tested my smoke detector. No, I have not tested my smoke detector.

Do you have a fire extinguisher? Yes No

Have you inspected your fire extinguisher in the last 12 months? Yes, I have inspected my fire extinguisher. No, I have not inspected my fire extinguisher.

Do you have a fire alarm system? Yes No
If yes, what is the name of your alarm company:

Do you regularly store any flammable materials or ammunition in your home? Yes No
If yes, please explain:

Does your home or business use propane or natural gas? Yes No
If yes, where are any tanks located in proximity to the main structure (left side of structure, rear of structure, etc.):

Is oxygen or other medical equipment in use at your home or business? Yes No
If yes, please explain:

Does your home or business have a septic tank? Yes No
If yes, where is the tank(s) located in proximity to the main structure (left side of structure, rear of structure, etc.):

Is your home or business clearly visible from the street, and is the address clearly numbered or marked? Yes No
If no, please provide directions below to include any landmarks, mileages, etc. that can assist in locating your home or business.
If possible, please assist Harris County emergency services by making sure your address is clearly numbered or marked.

Tell Us About The Occupants Of Your Home or Business

How many occupants reside in your home or work at your place of business:

If responding regarding your home, what are the ages of the occupants:

Does anyone in your home have disabilities or require special needs? Yes No
If yes, please explain:

Do you have pets? Yes No

Pet type:            Is this pet aggressive?    Yes           No
Pet type:            Is this pet aggressive?    Yes           No
Pet type:            Is this pet aggressive?    Yes           No
Pet type:            Is this pet aggressive?    Yes           No
Pet type:            Is this pet aggressive?    Yes           No

Other:

Additional Information

Please provide any additional information you feel is important that may assist Harris County
emergency services should an emergency arise at your home or business:

All information provided in this survey remains confidential and secure within Antioch Volunteer Fire Department.

Antioch Volunteer Fire Department
5430 GA HWY 219
Fortson, GA 31808

Homeland Security Advisory

Phone: (706) 576.5559
EMERGENCY: Dial 911
info@antiochvfd.org