Emergency Notification Form

Bucks County Emergency Management Agency

Main - Hazardous Materials - Do's and Don'ts of Water Conservation - Citizens Guide - Emergency Notification Form

911Freedom Way
Ivyland, PA 18974
Phone 215-340-8700

There may be a time when an emergency
takes place in your community due to
an airborne chemical release, power
outage, storm, water emergency or
other hazardous condition.

Vital information may be needed to be
distributed to residents and businesses
in your area in a rapid fashion.
Telephone Notification

The Bucks County Commissioners have
acquired the services of Community
Alert Network (CAN). Community Alert
Network has a computerized telephone
system that can target a general area
within your township or borough
or a specific area and send messages
to over 13,000 phones per hour. If
there was an emergency that might be
a risk to your community, the Local
or County Office of Emergency
Management would activate the CAN system.

This form is intended for all homes and
business owners, renters or tenants. Please
complete this form and re-direct it to the
Bucks County Emergency Management
Office AS SOON AS POSSIBLE. Your
physical address and telephone
numbers will be incorporated
into the CAN Emergency Telephone Database.

Please specify the Township or Borough
that you live in, this is very important.

This emergency notification could save
your life. Please act now and forward your
unlisted number.
Fill in the blanks below and click on the
Submit form at the bottom to sende
Name (Required)
Address (Required)
City (Required)
Township/Borough (Required)
State (Required)
Zip (Required)
Do you live on the Neshaminy Creek?
Telephone
I have an unlisted telephone number and wish to
be included in the emergency telephone
notification system. Telephone numbers WILL NOT
be given to other agencies and CAN
will not divulge or sell the numbers.

If you have more than one unlisted telephone
number you will need to complete a new form
for each number.
Sample Message:
There has been a hazardous material spill in your area with a cloud coming your direction.
Please close your doors and windows, shut off your air conditioner and stay inside until
the area is clear. Tune to your local radio station for other directions. Do not dial
9-1-1 unless it is an emergency.