Florida Firefighters Safety & Health Collaborative

The Florida Firefighters Safety & Health Collaborative is a free program to fire departments looking to enhance and maintain an effective safety committee or safety program.

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The Collaborative provides free training, protocols, and guidelines that support best practices as they relate to safety and health in the fire service. Contact us today to learn more about how you can help.
Peer Support Registration

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Peer Support Registration Form

The information collected on this Peer Support Data Entry Form will be utilized to populate the FFSHC Peer Provider web-based Resource List to link first responders and their families across the state of Florida to trained peer support providers. The supplied email address will be used to provide information to disseminate upcoming training opportunities and events. Submitted photos will be pre-screened prior to posting.
First Name*
First Name Required

Last Name*
Last Name Required

Email*
Email Required

Please upload a personal picture (.jpg) for use with your profile .
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Does your organization have an active peer team?*
Required

Type of peer training utilized (Organization Name)
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Phone*
Phone Number Required

Gender*
Gender Required

Preferred method of communication?*
Required

Does your organization have a guideline or operation procedure?*
Required

Please upload the document (.pdf) if available.
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This location will be used for regional response activation requests.
Street Address
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Apt / Suite
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City
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State
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Zip Code
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Rank
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Please list rank
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Are you a veteran?
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Please select military branch
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Special Discipline
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Specialties
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Significant injuries or life changing events you have experienced
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Are you married?
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What is the age of your spouse?
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How many children do you have?
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Please list the age and gender of each of your children.
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How many step children do you have?
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Please list the age and gender of each of your step children.
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Have you ever been divorced?
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How many times have you been divorced?
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What is your religious affiliation?
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Are you a chaplain?
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How many grandchildren do you have?
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Please list the age and gender of each of your grandchildren.
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Have you ever had cancer?
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Type of Cancer
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How many years in remission?
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What type of therapy was utilized?
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Have you ever considered or attempted suicide?
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What types of therapy/treatments/programs have you utilized that have provided a healthy and effective path towards healing?
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Please provide any additional personal bio information you feel is relevant.
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Please list any other attributes pertaining to your life experiences and specific skill sets that you identify as a strength as a peer to peer support member.
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Our Ethics Policy

The Florida Firefighters Safety & Health Collaborative is an organization formed to provide our members shared knowledge and resources based on best practices and research available from a myriad of confirmed resources. This website serves as a vehicle to share this information. It is not the intent of our Collaborative to operate for the benefit of private interests, to sponsor or endorse ANY specific agency, vendor, manufacturer or product. Nor is it our intent to support or endorse any political candidate or campaign for elected public office.

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