Emergency Notification Form

Every year, Port Coquitlam homes receive an Emergency Notification Form with their water and sewer bill, and are asked to provide medical information or cautionary notes about themselves and/or their property to help firefighters if an emergency occurs.

In particular, residents requiring special assistance in the event of an emergency evacuation are asked to complete the form.

The form may be filled out below, downloaded in PDF format (see link at left) or picked up from #1 Fire Hall at 1725 Broadway Street from 8 am to 4:30 pm, Monday to Friday.

Note: Please only fill out the form if you have something to report, as forms containing blank, “None”, “N/A”, etc. in both of the Person(s) and Circumstance(s) fields will not be entered into our CAD system. Likewise, information that falls within our normal operating procedures will also not be entered.

For assistance with this form, please contact 604.927.5466 or email fire@portcoquitlam.ca.


Forms only need to be submitted if there is a medical need, mobility issue, cautionary notes or special access instructions to report.
The form must be submitted annually.
Information from the previous year is automatically deleted from the system each April to ensure the information is up to date.

Submit your Notification Form online

Dispatch Citizen Information Form
Personal information collected on this form by the City of Port Coquitlam will only be used for the purposes for which it was collected under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA). If you have any questions regarding the collection of this information, please contact the City’s Records and FOIPPA Administrator at 604-927-5250 or clerks@portcoquitlam.ca.
Postal Code


Tel  604.927.5466
Fax  604.927.5406
Email  fire@portcoquitlam.ca

Location and Mailing Address

#1 Fire Hall, 1725 Broadway Street
Port Coquitlam BC  V3C 2M9

Administration Offices Business Hours: 

8:00 am to 4:00 pm, Monday to Friday (excluding statutory holidays)