Logan's List

Home > Organization > Support Operations Command > Communications Division > E911 > Logan's List

Special Concerns Response Information Logan's Law (HB 631)

Note: This information is valid for six (6) months. Please resubmit to remain on the list.

General Information About the Special Concerns Person

Name

First Name

Last Name

Nickname

Address

City

State/Province

Zip/Postal

Address

Home Telephone Phone

Cell Phone Number

Birthdate

Race

Gender

Height

Weight

Hair Color

Eye Color

Employer/School Address (Only if in Clayton County)

Special Concern or Condition:

Medications

How does this medication affect actions, responses, senses, the potential for violence, etc. ?

Please list any activations or triggers which may escalate an encounter. What actions should be avoided, if possible, by first responders?

Suggestions and techniques that can be taken to resolve a confrontation successfully?

This person is:

Responsible Party Completing This Form

Name

First Name

Last Name

Relationship:

Address

City

State/Province

Zip/Postal

Address

Home Telephone Number:

Cell Phone Number:

Email

Signature

Clear

By providing an email address, you agree to be sent email related to the Logan's List request.

Emergency Contact Information

Name

First Name

Last Name

Relationship:

Address

City

State/Province

Zip/Postal

Address

Home Telephone Number:

Cell Phone Number

If you are human, leave this field blank.