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Previous Inductions
Inductees 1998
Inductees 1999
Inductees 2000
Inductees 2001
Inductees 2002
Inductees 2003
Inductees 2004
Inductees 2006
Inductees 2008
Inductees 2010
Inductees 2016
Hall of Fame Wear
Events
Nominations
Support
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Firefighter/Law Enforcement Heroism Form
Name
First
Last
Email
Phone
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Please attach an accompanying photograph.
Max. file size: 256 MB.
Fire or Police Service Affiliation
Date of Rescue/Incident:
(Required)
Month
Day
Year
Location of Rescue/Incident (include address):
(Required)
Construction / Area (sq. ft.) / Height / Occupancy
Floor where act took place / Room
If not in building give complete descriptive information so that physical setting can be recreated.
Are any other citations (or other state/national awards/honors) being recommended in connection with t
(Required)
Yes
No
Please describe conditions/situation upon arrival.
(Required)
Was member alone?
(Required)
Yes
No
Was SCBA worn (if application)?
Yes
No
Was a charged hose line in position to protect member performing the rescue (if applicable)?
Yes
No
Was complete protective clothing worn (turnout, ballistic vest)?
(Required)
Yes
No
Was member injured?
(Required)
Yes
No
Describe injuries
(Required)
Was victim injured?
(Required)
Yes
No
Describe injuries
(Required)
Was the victim removed from:
(Required)
Immediate fire area
Above the fire
Other area
Describe
(Required)
How was victim removed from premises?
(Required)
Carried
Dragged
Assisted
Was a ladder used in this rescue?
(Required)
Yes
No
If yes, indicate type, size and placement
What specific job was member performing at the time of rescue/incident?
(Required)
What danger did the member place himself in to perform the rescue or during this incident?
(Required)
Victim Aided
Name
(Required)
Address
City
State / Province / Region
ZIP / Postal Code
Age
Gender
EMS Provided: (describe)
(Required)
Hospitalized: (name of hospital, length of stay, diagnosis)
(Required)
Name of two members who actually witnessed act (If available).
Name of two civilians who actually witnessed act (If available).
Description of act: (please be as descriptive as possible to recreate the scene of the rescue, use as many pages as necessary, the more detailed the better):
(Required)
CAPTCHA
Home
About
Previous Inductions
Inductees 1998
Inductees 1999
Inductees 2000
Inductees 2001
Inductees 2002
Inductees 2003
Inductees 2004
Inductees 2006
Inductees 2008
Inductees 2010
Inductees 2016
Hall of Fame Wear
Events
Nominations
Support
Contact Us
