Form Center

2. Agawam Fire Department Extra Duty Report
4. First Name*
5. Last Name*
7. Email address
9. Duty Type*

   Select one. If selecting "other" note duty below

   1. HAZMAT Training
   2. HAZMAT Response
   3. HAZMAT Detail
   4. WMTRT Training
   5. WMTRT Response
   6. WMTRT Detail
   7. Opiate Outreach
   8. Other
11. Other Duty Description
13. Duty Location (city / town)*
15. Duty Start Date and Time*
    Duty Start Date and Time

    Duty Start Date and Time
16. Duty End Date and Time*
    Duty End Date and Time

    Duty End Date and Time
18. Attendance for this period is:*

    1. Overtime (not scheduled to work)
    2. Straight time (scheduled to work)
20. Comments
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field