Special Assistance For Emergencies (SAFE)

This form is completed by the individual or their guardian for the purpose of notifying the Town of Brookline’s Public Safety Team of any special accommodations of the occupant(s) should there be a public safety emergency at the residence OR an area event impacting the public utilities or travel abilities. i.e., Snow- Ice storm that has closed roadways, Wind Event that has caused power outages.

This form is voluntary and NOT required by the Town.

Instructions: Please complete the below form and return it to the Ambulance Chief’s Office located at the Safety Complex 3 Post Office Drive Brookline, NH 03033.

Email the Ambulance Chief - click here.

SAFE form - click here