There was an error during the processing of your form. Please try again later.
Use this form to provide initial notification to the Arkansas Fallen Firefighters Memorial of an on-duty firefighter fatality.
Step 1 of 2: Fire Department information. Please complete the fields below and provide us with the details of where the decedent served.
Enter the department phone number above.
Step 2 of 2: Incident Characteristics
Please complete the selections in the form below, and provide a summary of the incident if desired.
Check if Firefighter was off-duty and died within 24 hours after engaging in non-routine stressful or strenuous physical activity while on duty (Hometown Heroes Act).
Check if the incident where the fatality occurred was a terrorist incident.
Check if the incident where the fatality occurred was a wildland incident.
Check if the incident where the fatality occurred was suspicious in nature or was ruled an arson fire.
Check if the firefighter was killed while responding to or returning from an emergency incident or working an emergency incident.
(Optional) Provide a brief description of the incident and how the fatality occurred.
Check the box to prove you are a human, not a robot.
Thank you for completing the form above. Your submission will be reviewed and someone from the Arkansas Fallen Firefighters will contact you soon.