HomeMy WebLinkAbout106.142a - FD-80 Line of Duty Death (LODD) Preferences Section 106.142a
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ADMINISTRATIVE MANUAL
STANDARIZED DOCUMENTS
106.142a LINE OF DUTY DEATH (LODD) PREFERENCES
(FD-80)
EFFECTIVE: OCTOBER 2013
Current Revision Date: 1/14/2022 Next Revision Date: 1/14/27
Author’s Name/Rank:
Lawrence R. French,
Administrative Battalion Chief Review Level: 1
Administrative Support:
Noemi E. Rogers-Rodriguez,
Management Analyst II ADA
PURPOSE
The purpose of this policy is to provide instruction to Fresno Fire Department (FFD or
Department) members on the use of the (FD-80) Line of Duty Death Preferences form.
The information you provide offers guidance to family, friends, and the Fire Chief
regarding members wishes to be carried out in the event of a line of duty death
(LODD).
APPLICATION
A member’s completed FD-80 form will be filed in the member’s personnel file. In the
event of an LODD, the Fire Chief, Duty Chief, and/or assigned staff may immediately
access personnel files.
OPERATIONAL POLICY
The information on the completed form is protected by the current laws, rules,
regulations, and policies regarding privacy and confidentiality as mandated by the
Department, the State of California, and/or any other agency or branch of government.
OPERATIONAL GUIDELINE
Members should review Administrative Manual, Section 114.001, Line-of-Duty-Death
Procedure and 114.002, Memorial Procedures, prior to careful completion of this form.
If a particular item does not apply to the member completing the form, or the member
prefers not to provide the information requested, specify by writing “N/A” in response
to the question. This form is accessible to members in electronic form at FFD Training
(TargetSolutions LMS) > File Center > Manuals and Forms > Forms. A
TargetSolutions/LMS assignment will be assigned to members annually with a link to
the form. All forms are to be completed electronically, printed, and signed and dated
Section 106.142a
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by the member completing the form. Please maintain a copy of the completed form
for your records.
Members may submit a revised FD-80 at any time, signed and dated, with written
direction to replace the current form on file. To maintain current information and
ensure document integrity for all members, the Department will provide an annual
reminder to update FD-80 forms.
PROCESS
Members have the following options to submit an updated and signed FD-80 form:
Hand deliver updated and signed FD-80 in a pre-labeled, sealed envelope directly
to the administrative battalion chief in the Personnel Division at FFD Headquarters.
1. Envelopes are provided to the battalion chiefs for each station for
submittal of your FD-80. Contact the management analyst II in the
Personnel Division to request more as needed. Envelope labels will
contain the following information; please provide the requested
information and check the appropriate boxes before submitting.
FD-80 LODD PREFERENCES
Name: _______________________________________________
Employee ID No.: _____________ Date: ___________________
Enclosed is my updated and signed FD-80 form
Please place this new form in my Personnel File
Return the old form to me - or -
Please shred the old form
Rec’d by HQ Admin Staff and Filed on:
2. Give an updated FD-80 to a battalion chief for delivery to the administrative
battalion chief in the Personnel Division in a pre-labeled, sealed envelope.
Upon receipt of an updated FD-80, the Personnel Division will email respective
members acknowledging receipt and filing of their FD-80 form.
INFORMATION
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Section 106.142a
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DEFINITIONS
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CROSS REFERENCES
Administrative Manual
Section 114.001, Line-of-Duty-Death Procedure
Section 114.002, Memorial Procedures
LINE OF DUTY DEATH (LODD) PREFERENCES
FD-80
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Family Support Personnel:
One or more active Department personnel known to and trusted by surviving family
members may be designated as “Family Support Personnel.” This person (or persons)
may be included in the Notification Team, and/or assigned to provide emotional support
and assist surviving family members with decision-making.
1.
2.
3.
4.
Immediate Family Information Section:
All information provided below will be current and true as of the signature date on this
form.
In response to No. 4 (below), you may provide special instructions regarding notification
to your spouse/partner. Briefly include your preference and special notification
instructions. (For example, an entry could read as follows: Jane Doe. Jane is a teacher
and can best be reached Monday-Friday, during school hours. On the weekends, she
can be reached at home phone/cell number, etc.)
1. Your legal name:
2. Nickname/s you are known by:
3. Current home address:
4. Spouse/partner’s name:
Special Instructions:
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5. Number of children.
Please list your child(ren)’s name(s), age(s) address(es), and contact phone
number(s). If the child’s address is your current address, write “same”. Briefly
include your preference and special notification instructions. (For example, an
entry could read as follows: Julie Doe. Julie, age 18, 123 First Street, Fresno, CA
91111 (559) 222-2222. Julie lives with her mother and attends high school. I
would prefer Julie’s mother notify her, etc.)
Name Age Address Phone
Number Special Instructions
6. Parent’s name(s), address(es), and contact phone number(s).
Please briefly include your preference and special instructions for notification of a
parent. (For example, an entry could read as follows: John Doe. John is my
stepdad, age 82, 321 Main Street, New York, NY, 11111 (222) 999-9999. He lives
alone and is not in good health, etc. I would prefer my wife notify him.)
Name Age Address Phone
Number Special Instructions
7. Sibling’s name(s), address(es), and contact phone number(s). Please briefly
include your preference and special instructions for notification of a sibling.
Name Age Address Phone
Number Special Instructions
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8.
Name, address, and contact number of a family member not living in your
household who may need to be notified and/or included in decisions regarding the
information on this form.
Name Age Address Phone
Number Special Instructions
Faith (Religious) Information Section:
1. List your religious preference (if any):
2. Provide the name, address, and contact
number(s) of your preferred church,
chapel, or faith community.
3. Provide the name of a:
Priest Minister Pastor
Rabbi Deacon Other person
of faith of
your
preference.
4. Will the services be held in the city of
Fresno? Yes No
5. If services are not to be held in Fresno,
please provide the name of the
surrounding community where services
will be held.
6. If the services will be conducted out-of-
state, if reasonable, do you wish for the
Fresno Fire Department be represented
at the services?
Yes No
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Firefighter Funeral Section:
1. List any fraternal organizations that may request/require participation (e.g., rosary,
prayer service, official organizational service, etc.) at the wake or funeral (i.e.,
Knights of Columbus, Mason, Veterans of Foreign War, American Legion, etc.).
Please include name of organization, complete address, and contact phone
numbers.
Organization Address Phone Number
2. Provide the name and address of the
memorial service preference.
Funeral home Home Chapel
Church Other
If Other, please elaborate for ease of
planning.
3. Do you wish the designated person of
faith (as reflected in your response to
No. 11 above), be present and involved
in the service?
Yes No
If your answer is yes, please list any
specific roles or responsibilities to be
assigned.
4. Do you wish the Fresno Fire
Department Honor Guard to participate
in the service?
Yes No
If yes, list who should be the Pallbearers and/or Honorary Pallbearers.
Pallbearers:
a.
b.
c.
d.
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e.
f.
Honorary Pallbearers:
a.
b.
c.
5. Do you request a member of the
Department to provide a eulogy? Yes No
If yes, please list the name(s) of those you designate to fill this role.
a.
b.
c.
d.
e.
f.
6. Do you wish the Fresno Fire Department Honor Guard to
conduct the ringing of the Four-Fives? Yes No
7. Do you wish Communications to broadcast the last alarm? Yes No
8. Do you wish your casket to be transported on an engine? Yes No
If yes, please designate how you wish this to occur. Please provide name of
organizations, complete addresses, and contact phone numbers below:
Organization Address Phone Number
9. Would you like the United States flag to be presented to family
member(s) Yes No
To whom would you like the flag presented?
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Members of the Armed Services – Active, Retired, and Reserved Special Section:
1. Are you a veteran? Yes No
2. Are you active duty or reserve? Yes No
For active and reserve armed service members, list your unit and provide the
complete address and contact number(s) of your command squadron office.
Unit Address of Command Squadron Office Contact Number/s
3. Will “Taps” be performed by an armed service or veterans
organization? Yes No
4. Will the American flag folding/presentation be conducted at
the service? Yes No
If yes, please designate if the flag folding/presentation will be conducted by:
Armed service or veteran’s organization only
Honor Guard only
Agency combination
Line-of-Duty-Death (LODD) Special Section:
1. Following proper family notifications, do you want your photo
and name released to the news media? Yes No
Please include special preferences here:
2. Once immediate family notification has occurred, who else should be notified?
Please provide those names, complete addresses, and contact numbers. Briefly
include your preference and special instructions for notification of these
individuals. (For example, an entry could read as follows: Joe Smith, my best
friend, age 42, 322 Main Street, New York NY, 11111 (222) 888-8888. Joe and
my stepdad, John, are close friends and live near each other in New York. I know
they’ll want to be together through this rough time.)
Name Relationship Age Address Phone Number
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Other Pertinent Information Section:
1. Please list who you would like to clean out your locker.
a.
b.
c.
d.
2. Where would you prefer the belongings in your locker be sent?
a.
b.
c.
3. List any other pertinent information (using extra sheets if necessary).
Signature Date
Please type name