Disability Indicator Form
Request a disability indicator (Landline Telephone Service Subscribers Only)
If you have a disability and landline telephone service, you may qualify to have a unique code appear during 911 calls to indicate to emergency services that you may require special assistance.
What you need for Request a disability indicator (Landline Telephone Service Subscribers Only)
The Massachusetts Disability Indicator Program offers a free, voluntary service that alerts 9-1-1 personnel that an individual with a disability lives in the home and may have unique safety, communications or other needs in case of an emergency. This service was developed in consultation with organizations representing the mobility, hearing, speech and sight impaired communities. This service is available for landline telephone service subscribers only. t is necessary to request the service through completion of the Disability Indicator Form.
When 9-1-1 is dialed from a landline telephone, the 9-1-1 system automatically displays the caller’s name, address, and telephone number on the call taker’s screen. The information provided on the Disability Indicator Form enables a special code to appear on the call taker’s screen that alerts the call taker that a person residing at that address may require special assistance during an emergency. The information provided will only appear on the call taker’s screen when a 9-1-1 call originates from the address on the form.
How to request:https://www.mass.gov/…/request-a-disability-indicator-landl…
Forms are also available at the Police Department and the Town Hall Lobby.
When filling out the form, be sure to:
- Give your telephone number, name and address.
- Check the box or boxes.
- Sign and date the form.
- Return the form to your 911 Municipal Coordinator for processing.
Any questions should be referred to your Municipal Coordinator at:
Name: Suzann Anderson (for Southwick residents only)
Telephone Number: 413-569-5348 ext 609