Disability Indicator Form

You may complete this form if you’d like first responding agencies to know about any disabilities you may have when you call 9 -1-1 in an emergency.

When you call 9-1-1 from your landline phone, the 9-1-1 system automatically displays your name, address and telephone number on the Dispatcher’s screen.

At your request, codes will be displayed on the dispatcher’s screen that will identify the disability indicators that have been reported for you or someone living with you at your address. These codes will help the dispatcher to communicate with the caller and provide useful information to your responding public safety agency.

The information is confidential and will only appear at the dispatcher’s location when a 9-1-1 call originates from your address.

The information you provide for input to the 9-1-1 system will remain until you request a change or make a request to have it removed.

It is your responsibility to notify the Casper-Natrona County Public Safety Communications Center (PSCC) when there is a change in the information described on this form. When there is a change, complete another form and submit it.

If the disability indicator form is not completed properly, the information will not be entered into the 9-1-1 system.

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 using the instructions listed below

Any questions should be referred to the Casper-Natrona County Public Safety Communications Center (PSCC) at: (307) 235-8278

All forms must be submitted using the online form below, or mailed or e-mailed to the following addresses:

Lori Jackson
Casper Police Department
201 N David. Casper, WY 82601
ljackson@casperwy.gov
Fax: 307-235-7512.

9-1-1 Disability Indicator Form – Individual Record

The voluntary filing of this document with the Casper-Natrona County Public Safety Communications Center will alert public safety officials that an individual residing at your address communicates over the phone by a TTY and/or has a disability that may hinder evacuation or transport, or may not be able to comply. This information is confidential and will only appear at the dispatcher’s location when a 9-1-1 call originates from your address. The information will be communicated to the responding public agency.

The following are approved designations for inclusion in the 9-1-1 Database to assist public safety dispatchers in responding to an emergency at your address. This list of approved designations may be changed as is necessary and approved by the PSCC Manager.

Choose several(required)

Select from the following any of the assistance aids required by the Person with Disability

Choose any that apply

Choose one(required)

NOTICE: By initiating this document I understand that I am responsible for notifying my 9-1-1 Center of any changes with regard to the status of the above disability indicator(s). I understand this information will remain as part of my 9-1-1 record until such time as I notify my 9-1-1 Center to change or delete the same.

Printable Form