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2. Select a Choice*
   -- Select One --Community Risk ReductionPublic EducationFire InvestigationFire InspectionTrainingFire SuppressionEMSTechnical RescueHazardous MaterialsInformation TechnologyDomestic PreparednessFinancial ResourcesTechnical ServicesWellness/FitnessCommunicationsPhysical ResourcesFacilitiesTools & EquipmentGovt. & Admin.Human ResourcesWater ResourcesStrategic PlanSafetyApparatus Maintenance

   Select the program you are reviewing
4. First Name
   Lead member of program appraisal review:
5. Last Name
7. List all members who participated in appraisal review:
9. Was your program appraisal presented to a larger group?

   1. Yes
   2. No
   3. N/A
10. If yes, what date was/is it planned?
12. Does your program group meet regularly?

    1. Yes
    2. No
    3. N/A
16. Check the documents that you reviewed for this submittal. Note any significant plans or changes in the boxes below:

    1. Strategic Plans or goals related to program
    2. 9th Edition Self-Assessment Manual
    3. General Order associated with program
    4. Forms utilized by program
    5. Annual and Capital budget plans
    6. Standard of Cover
    7. Strategic Plan
    8. Records Mgmt. Program
18. Items/topics to highlight pertaining to documents above:
22. Summarize significant activities, goals and/or accomplishments from the past 12 months:
24. List any needs or issues for your program. Do you anticipate any challenges for the next 12 months?
26. Describe effectiveness of the program, or measurements of the program:
28. List any updates to the CFAI Strategic or Specific Recommendations:
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

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