Virginia Fire Chiefs Association
Guide to Survivors Benefits
| Available Benefits | Public Safety Officer Benefit |
| Scholarships | Memorial Services |
| National Fallen Firefighters | Items Requested/Needed |
| Virginia LODD Benefits | Employee Emergency Contact Information Sheet |
The Virginia Fire Chiefs Association recognizes and is sincerely grateful for your unselfish devotion to the citizens and visitors of the Commonwealth of Virginia. It is this unselfish devotion and commitment to saving lives and preserving property that pushes us to perform heroic and brave acts during times of uncertainty. It is these same heroic acts that sometimes cause us to bid a sad farewell to a brother or sister who has made the supreme sacrifice while answering their call to duty.
The purpose of this guide is to assist you and your families to better understand the benefits that are available to them and the steps necessary to acquire such benefits at the National, State, and Local levels of government.
After a Line-of-Duty Death
When a line-of-duty death occurs, it is
overwhelming for the department and the family. Here are a few steps that the
department needs to take immediately to help the family and the department.
1. Immediately contact the Department of Justice’s Public Safety Officers’
Benefits (PSOB) Program at (888) 744-6513. PSOB offers financial assistance to
survivors of public safety officers who die in the line of duty from a traumatic
injury. There are many procedures that need to be followed so survivors can
receive benefits to which they are entitled. Call PSOB even if you are not sure
whether your firefighter's family will qualify for benefits under this program.
2. Contact the National Fallen Firefighters Foundation at (301) 447-1365 for
assistance through the Chief-to-Chief Network, including a checklist of what
needs to be done immediately, before the funeral and afterwards. We can also
provide information on how to support the family and coworkers during this
difficult time.
The Foundation also sponsors the annual
National Fallen Firefighters Memorial Weekend. Fallen firefighters who meet the
criteria for inclusion will be honored at the National Memorial Service the
following year. For instance, a firefighter who died in the line of duty in 2000
will be honored at the 2001 Memorial Service.
When you report a firefighter death, please have the following information
available:
Fallen
Firefighter Information:
1. Fallen firefighter’s name
2. Status (career, volunteer, contract, other)
3. Age
4. Date of incident
5. Date of death and date of funeral
6. Description of incident/cause of death
Department Information:
1. Name of chief
2. Name of department
3. Address
4. Phone and fax numbers
5. Email address (if available)
Next-of-Kin Information:
1. Name
2. Relationship
3. Address
4. Phone number
In addition, contact
the United States Fire Administration (USFA) at (301) 447-1350. The USFA will
post the firefighter’s name at the national monument site and lower flags to
half-staff in honor of the firefighter.
Criteria for Inclusion on the National Memorial
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Since
1981, America has honored its fallen firefighters at an annual ceremony
held on the National Fire Academy campus in Emmitsburg, Maryland. In
1990, Congress passed legislation making the monument in Emmitsburg,
Maryland, the "official national memorial to volunteer and career
firefighters who die in the line of duty." In 1997, fire service
leaders adopted the following criteria for inclusion at the National
Memorial. The Foundation is responsible for final determination of
eligibility. |
Official Criteria
Firefighters who die in the line of duty
shall be honored at the National Fallen Firefighters Memorial in Emmitsburg,
Maryland. Line-of-duty deaths shall be determined by the following standards:
(a) Deaths meeting the Department of Justice's Public Safety Officers' Benefits
(PSOB) program guidelines, and those cases that appear to meet these guidelines
whether or not PSOB staff has adjudicated the specific case prior to the annual
National Fallen Firefighters Memorial Service; and
(b) Deaths from injuries, heart attacks or illnesses directly attributable to a
specific emergency incident or training activity.
2. While PSOB guidelines cover only public
safety officers, the new criteria also include private firefighters, such as
those in an industrial brigade, provided the deaths meet the standards listed
above.
3. Some specific cases will be excluded from consideration, such as deaths
attributable to suicide, alcohol or substance abuse, and other gross abuses.
Review Process
Using the criteria, the U.S. Fire Administration (USFA) will prepare a list of eligible firefighters, including information on the reasons for inclusion. The USFA will also prepare a list of individuals deemed ineligible, with an explanation for each situation. The Foundation's Executive Board will review the USFA list and recommend a final list for inclusion.
Individuals may submit requests for reconsideration of eligibility or
for consideration of names previously omitted. When necessary, the full Board
will act on these requests at its Annual Meeting. The Foundation will add
eligible firefighters' names at subsequent national tributes.
For more information, contact the National Fallen Firefighters Foundation.
Public Safety Officers Benefit
Administered
by the U.S. Department of Justice
$
283,385.00
Commonwealth of Virginia Funeral Benefit
Administered by the VA Workers’ Compensation
Commission
$
10,000.00
Additional Travel Expense up to
$
1,000.00
Commonwealth of
Virginia One-Time Death Benefit
$100,000 to the beneficiary if the death occurred
while in the line of duty. If the death was caused by a respiratory disease,
hypertension, or heart disease, it will be presumed to be a line-of-duty death
and the beneficiary shall be entitled to receive the sum of $25,000.
Also, continued
health insurance coverage is provided for the spouse and any dependents.
Workers'
Compensation
Benefit is 2/3 of decedent's average weekly wage to dependents with a weekly minimum and maximum; amounts change every year. Dependents defined as a surviving spouse, a child under 18 or beyond if disabled, or under 23 if full-time student. Parents may also be considered dependents if destitute and there are no other total dependents. Child includes stepchild, legally adopted child, posthumous child, and an acknowledged illegitimate child. Parents include stepparents or parents by adoption.
Education
Benefit - Children
Free
undergraduate tuition and required educational and auxiliary fees for children
aged 16-25 at any public
institution of higher learning in Virginia.
Does not include room and board.
Education Benefit -
Spouse
Free
undergraduate tuition and required educational and auxiliary fees for children
aged 16-25 at any public
institution of higher learning in Virginia.
Does not include room and board.
Virginia
Retirement System
Death-in-Service
Benefit: If you die while employed in a VRS-covered position, the person
you
have named as the beneficiary for your member contribution account is eligible
to receive a
lump-sum
payment of your account contributions. If
the person named as your beneficiary for
your
member account is your spouse, minor child, mother or father, he or she may
choose either
the
lump-sum payment of the member contribution account or the monthly death
in-service
benefit.
If you have named more than one primary beneficiary, the first person
named in order
of
precedence specified by law is eligible to receive the benefit to the exclusion
of the other
named
beneficiaries. If your beneficiary
is your minor child, benefits cease when the child
reaches the age of 18 years. The formula used to calculate the
amount of the monthly benefit
takes into consideration your age, the age of your
beneficiary, your average final compensation
and your years of service credit. If your beneficiary chooses
the monthly benefit, he or she
receives a monthly benefit equal to the amount you would have
received if you had retired
under the 100% Survivor Option on the day of your death. If
you have not named a beneficiary,
benefits are paid according to the order of precedence. The
death-in-service benefit is paid in
addition
to any life insurance coverage you may have.
Virginia
Retirement System Basic Group Life Insurance
Amount of Coverage
The
amount of basic group life insurance is equal to your annual salary rounded to
the next highest thousand, and then doubled.
For example, if your annual salary is $25,200, it is rounded up to the
next highest thousand - $26,000. When
doubled it is $52,000 for natural death. For accidental death, the amount is
doubled again, so it would be $104,000 ($52,000 natural death benefit and
$52,000 for accidental death). Basic group life insurance is subject to imputed
income taxes. This means that if
your combined coverage exceeds $50,000, the value of the coverage in excess of
$50,000 may be subject to FICA and federal and state income taxes. The value used to determine imputed income is based on a
table provided by the Internal Revenue Service, not by VRS or the insurance
carrier.
Dismemberment
Coverage
You receive a payment equal to your salary rounded to the next highest thousand for the accidental loss of one limb or the sight of one eye. You receive a payment equal to your salary rounded to the next highest thousand and doubled, for the loss of two or more limbs or the total loss of eyesight.
Virginia
Retirement System Optional Group Life Insurance
If you have basic group life coverage, you are eligible to purchase optional group life insurance for natural and accidental death and dismemberment for yourself and your family. You can purchase the optional group life insurance coverage for one, two, three, or up to four times your salary, not to exceed $500,000. Benefits are computed as in the Basic Group Life Insurance coverage up to amount you have selected as coverage (e.g. 1x 2x 3x or 4x your average salary).
SCHOLARSHIPS
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National Scholarship
Programs |
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|
National Fallen Firefighters
Foundation Offers annual financial assistance for
higher education and training to spouses and children of firefighters
honored at the National Memorial in Emmitsburg, Maryland. Public Safety Officers' Educational
Assistance Program (PSOEA) Provides support for higher education
expenses through an established monthly allowance for eligible survivors.
This Department of Justice assistance program is limited to survivors who
qualified for Public Safety Officers' Benefits program. This program now
covers eligible survivors of Federal, state, and local fire and emergency
services personnel killed in the line of duty since January 1, 1978. See PSOEA Factsheet on this CD International Association of Fire
Fighters Makes annual scholarship awards
available to children of firefighters who died in the line of duty. The
applicant's parent must have been a member in good standing of the
International Association of Fire Fighters at the time of death. MasterGuard's Fallen Heroes
Scholarship Fund Offers annual financial assistance for
higher education and training to families of firefighters honored at the
National Memorial in Emmitsburg, Maryland. Children under age 30 and
spouses are eligible for support. John Heinz Memorial Scholarship Fund Established by Congress as part of
Public Law 102-406, the purpose of the fund is to provide educational
scholarships to the surviving children and spouses of fallen firefighters
and emergency medical personnel, as qualified under the Department of
Justice's Public Safety Officers' Benefits Program, who died in the line
of duty on or after September 12, 1992. |
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W. H. "Howie" McClennan Scholarship
Purpose:
The W. H. "Howie" McClennan scholarship provides
financial assistance for sons, daughters or legally adopted children of fire
fighters killed in the line of duty planning to attend a university, accredited
college or other institution of higher learning.
Application Deadline: February 1
Amount of Scholarship: $2,500/year
Award Dates:
Scholarships are awarded annually, on or before August 1 for
the proceeding academic year. They may be renewed (if approved) up to four
consecutive years.
Selection Criteria:
Awards are based on financial need, aptitude promise and
demonstrated academic achievement. For a complete description of selection
criteria, see the W. H. McClennan Scholarship Rules File on this CD.
How to Apply:
All applicants, both new and renewal applicants, must submit
all application materials. Applications materials include:
A completed Scholarship
Application Form.
An official copy of a school
transcript and grade report from the school currently attending or most recently
attended. The official school transcript should list all grade points earned and
academic course work completed to date.
A brief statement (about 200
words) prepared by the applicant that indicates their reasons for wanting to
continue their education.
Two letters of recommendation from a teacher, school administrator, counselor, clergy, work supervisor or military supervisor (active, reserve or National Guard) who can address the qualifications and academic aptitude of the scholarship applicant. The required letters of recommendation may not be from immediate family members, close family friends, blood relatives, or relationships by marriage.
Send To:
W. H. "Howie" McClennan Scholarship
Office of the General President
The International Association of Fire Fighters
1750 New York Avenue, N.W.
Washington, D.C. 20006
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MasterGuard's Fallen Heroes Scholarship Fund |
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Each year a portion of the proceeds from the sale of MasterGuard's
early warning fire protection equipment goes to The Education Fund. From
this fund, they sponsor the MasterGuard Fallen Heroes Scholarship Fund.
The Fallen Heroes Fund seeks to offer education opportunity to the
children and spouses of our fallen firefighters. |
|
Applications (See NFFF Scholarship Application on this CD) must be
postmarked by May 1 for consideration. For more information contact: Mr. Chris Roberts Eligibility
Requirements Spouse, child, or stepchild of a fallen firefighter honored at the
National Fallen Firefighters Memorial in Emmitsburg, Maryland. Children
must currently be under the age of 30 or have been under the age of 22 at
the time of their firefighter's death. High school
diploma or equivalency or in the final year of high school. Currently
pursuing or planning to pursue undergraduate or graduate studies, a
certification program or job skills training at an accredited university. Currently
enrolled or planning to enroll as a full- or part-time student. Selection
Criteria Academic standing Statement of
Interest including personal, academic and career goals as well as
involvement in extracurricular activities, including community and
volunteer activities Two letters
of recommendation, at least one from a member of the fire service |
Paul Sarbanes Scholarship Program
National Fallen Firefighters Foundation
Offers
annual financial assistance for higher education and training to families of
firefighters honored at the National Memorial in Emmitsburg, Maryland.
Children under age 30 and spouses are eligible for support.
For more information, visit www.firehero.org or contact the Foundation at
firehero@erols.com. or (301) 447-1365.
In 1996, the
Foundation’s Board of Directors established a scholarship program named in
honor of U. S. Senator Paul S. Sarbanes of Maryland, a longtime supporter of the
fire service.
The Foundation's scholarship program can help spouses and children of fallen
firefighters with educational and job training costs. This program "fills
in" when state educational benefits aren't available. Applications must be
postmarked by April 1 for consideration. For more information contact us.
Eligibility
·
Spouse,
son, daughter, legally-adopted child, or stepchild of a fallen firefighter who
met the criteria for inclusion on the National Fallen Firefighters Memorial in
Emmitsburg, Maryland. Children of fallen firefighters must be under age 30.
·
Applicant
must have high school diploma or equivalency or be within the final year of high
school.
·
Applicant
must be pursuing or planning to pursue undergraduate or graduate studies, or job
skills training at an accredited university, college, community college, or
technical school.
·
Full and
part-time students are eligible.
·
Demonstrate
academic and personal potential.
Criteria
·
Academic
standing (minimum 2.0 grade point ratio or "C" average)
·
Involvement
in extracurricular activities, including community and volunteer activities
·
Personal
Statement
· Two letters of recommendation; at least one should be from a member of the fire service
Commonwealth
of Virginia Scholarship Programs
Virginia
Public Safety Foundation. Financial
aid to the families of firefighters killed in the line of duty. Educational benefits in the form of grants available to the
children and the spouse of firefighters that have been killed in the line of
duty. The grant may cover room and
board or books (those expenses which the Commonwealth of Virginia does not
cover). Merit scholarships also
available for the children and spouses.
Contact:
1604 Santa Rosa Road
Suite 115
Richmond, VA 23229
(804) 282-0148
The
United States Congress created the National Fallen Firefighters Foundation to
lead a nationwide effort to remember America’s fallen firefighters through a
variety of activities. Since 1992, the tax- exempt, nonprofit Foundation has
developed and expanded programs to honor our fallen fire heroes and assist their
families and coworkers.
The Foundation is a 501(c) 3 nonprofit organization, located in Emmitsburg,
Maryland. It is registered as a corporation in the State of Maryland. The
Foundation receives funding through private donations from individuals,
organizations, corporations, and foundations.
A grant from the Department of Justice's Bureau of Justice Assistance supports programs for survivors of fallen firefighters. The Federal Emergency Management Agency partners with the Foundation to sponsor many of the National Memorial Weekend activities.
Families of fallen firefighters face a long and difficult journey. When a loved one dies suddenly, it can change everything. While the rest of the world seems to move on, family members must find a new way to live in the world without the person they loved. The Foundation offers programs to help fire service survivors during this most difficult time.
Various Programs and Services Available from the
National Fallen Firefighters Foundation include but are not limited to the
following. We encourage survivors and fire departments to contact the Foundation
for more information about this and other services for families.
National
Fallen Firefighters Memorial Weekend and Service
Each
October, a grateful nation honors its fallen fire heroes during the National
Fallen Firefighters Memorial Weekend. Rich in fire service tradition; the
Weekend celebrates how these brave men and women lived and what they represented
in their communities. Thousands of people attend the private and public events held on the campus of
the National Fire Academy in Emmitsburg, Maryland. Fire service personnel from
across the country volunteer to serve as family escorts and assist with weekend
activities. Hundreds of Honor Guard members join together in a show of respect
to their fallen comrades and their families. It is a Weekend that reminds
everyone of the very special bond shared by the fire service family.
Helping survivors attend the Weekend
Through private and corporate donations the
Foundation provides lodging and meals for immediate survivors and assists with
travel expenses when needed. This support allows family members to participate
in Family Day sessions conducted by trained grief counselors and in the public
tributes to their loved ones.
What are the
costs associated with the Weekend for families?
We
truly believe every family should have the opportunity to experience the
Nation’s outpouring of love and gratitude for your loved one and the other
brave men and women honored during this weekend. Private donations help the
Foundation provide lodging for the immediate next-of-kin. Additional family
members who would like to attend the weekend are responsible for their own
lodging. The Foundation will provide meals to all family members who attend.
Activities for Returning Survivors
The National Fallen Firefighters Foundation invites all survivors whose loved
one was previously honored on the Memorial to join us for this year’s National
Memorial Weekend on October 6-7, 2001. As a returning survivor, you will have
opportunities to participate in the Weekend activities, reconnect with people
you met in previous years, and reach out to families attending for the first
time.
On Family Day, Saturday, October 6, we will offer small group sessions for both
new and returning survivors in the afternoon. There will also be many
opportunities for returning survivors to help out during the Weekend.
Returning survivors will receive on-campus meals free of charge during the
Weekend. However, the Foundation cannot pay lodging costs for returning families
to attend the Weekend. You will be responsible for travel arrangements from your
home to Emmitsburg. We can provide you with a list of local hotels, and we
encourage you to make reservations soon.
If you would like to attend the Memorial Weekend, please let us know. We will
send you the information and registration forms.
Survivor
Support Network
Under
a grant from the Department of Justice, the Foundation has established a
Survivor Support Network. The network is a group of "experienced"
survivors who can lend emotional support to survivors in the difficult months
after a death.
Network participants are matched with survivors of
similar experiences and circumstances. For instance, a family who lost a loved
one close to a holiday can talk to another survivor about how they have coped.
Survivors who are facing a long and painful trial can talk to others who have
already been through the ordeal. And recently widowed women who are suddenly
raising children alone have other women to turn to. This type of support is
important, as only a survivor can fully understand another survivor's
experiences. Many fire service survivors have never met others who understand
what it is like to love and lose a firefighter. Sometimes, simply talking with
someone who has made a similar journey can offer a sense of hope.
Remembrance
Program
The anniversary date of the death of a loved one is often difficult for the
family. Survivors receive a remembrance card during the month of their
firefighter's death. The card, written by another fire service survivor, reminds
the family that others remember and care.
Newsletters
The
Foundation publishes a quarterly newsletter for survivors of fallen
firefighters. The newsletter focuses on family issues, provides information on
benefits and programs, and helps survivors keep in touch with each other. If you
are interested in receiving this informative newsletter, please contact us at firehero@erols.com.
The
newsletter includes a special section called the "Family Corner" where
families can share important news such as births, graduations, marriages,
awards, etc. If you would like to submit news for the "Family Corner",
just contact us.
Grief Brochures
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National Fallen Firefighters
Foundation |
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The Foundation has the following brochures available for survivors of
fallen firefighters and those who assist them. To Order Grief Brochures, please contact the National Fallen
Firefighters Foundation. |
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For
Anyone Who Is Grieving Do and Don't Healing Grief* Helping Men Homicide: A Brutal Bereavement Tinsel and Tears: A Holiday Guide Yourself and Grief* For
Grieving Spouses When a Spouse Dies: Until Death Do Us Part For
Grieving Parents and Grandparents The Death of a Child Grandparents Grieve Twice Healing a Father's Grief For
Grieving Children and Their Parents and Caregivers
Children’s Grief Just for Kids* Loss Sibling Grief For
Support People For a Friend Grief in the Workplace Is There Anything I Can Do to Help?* *Spanish version also available. |
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Lending
Library
The
Foundation has created a Lending Library of materials for survivors. Survivors,
people who know firsthand what it is like to lose a loved one, have written many
of the books. The Library also contains some audio and videotapes, including
tapes of previous Memorial Weekends.
The Library includes books for parents who have lost an adult child, books for
young widows, and books to help children deal with death. Fire service survivors
can borrow materials free of charge for up to 4 weeks at a time.
Contact
the Foundation to request Lending Library materials. We will mail your requests
out to you, along with a postage-paid return mailer. If you know of a good book,
tape, or video that we should add to the
Lending Library, please let us knows.
The Foundation has materials in the following categories:
·
General Grief
Resources
·
For Spouses
·
For Children
& Teens (& their parents)
·
For Parents
·
For Adults Who
Have Lost a Parent
·
For Friends,
Coworkers, etc.
·
For Men
·
Coping With
Holidays
· Audio and Video
· Spiritual/Meditations
Brief Overview of Virginia LODD Benefits
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One-time Death Benefit |
$100,000 to beneficiary if death occurred as a direct
or proximate result of performance of duty. If death was caused by a respiratory disease, hypertension, heart
disease, or some forms of cancer, it may be presumed to be duty-related if
it occurs out of or in the course of employment or within five years after
retirement. In these cases, the beneficiary shall be entitled to receive
the sum of $25,000. Contact: Office of the
Comptroller, Department of Accounts, James Monroe Building, 101 N. 14th
Street, Richmond, VA 23219-3684 --- (804) 225-3038. |
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Workers' Compensation |
Benefit is 66 2/3% of employee's average weekly wage.
Minimum and maximum amounts apply and are adjusted annually. Benefits
continue for a period of 500 weeks from the date of injury and are divided
equally among total dependents. Dependents include surviving spouse and
children under age 18, under age 23 if a full-time student, or longer if
disabled. Stepchildren are eligible for benefits. Upon remarriage, spousal
benefits are terminated and shall be divided among the children or other
dependents. Volunteer firefighters:
Volunteer firefighters are considered employees if designated as such by
their political subdivisions or if their companies elect to cover
volunteers. When they are deemed employees, average weekly wage shall be
deemed sufficient to produce the minimum compensation. Contact: Virginia Workers’
Compensation Commission, 1000 DMV Drive, Richmond, VA 23220 --- (804)
367-8600. |
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Funeral Benefit |
Maximum of $10,000 for burial expenses, plus up to
$1,000 for transportation of the deceased. Contact: Workers’
Compensation, as listed above. |
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Retirement/Pension Plan |
Career firefighters: If a firefighter employed
in a Virginia Retirement System position dies from work-related causes,
the spouse, minor children, or parent receives 50% of the average final
compensation if the beneficiary does not qualify for Social Security
survivor benefits. If the beneficiary does qualify for Social Security,
the retirement benefit is reduced to 33 1/3% of the average final
compensation. This benefit is reduced by Workers’ Compensation benefits.
The beneficiary also receives a refund of contributions and interest
credited to the firefighter’s account. Upon remarriage, monthly benefits terminate. If there are minor
children at the time of remarriage, they will receive the monthly benefit
until age 18. If survivor is a minor child, the benefit ends at age 18. The death benefit is paid in addition to any life insurance coverage
the firefighter may have had. The life insurance provides a double
indemnity for accidental death. Contact: Virginia Retirement
System, P.O. Box 2500, Richmond, VA 23218-2500 --- (804) 649-8059 ---
(888) 827-3847 --- www.state.va.us/vrs/vrs.htm. Volunteer firefighters:
Volunteer Firefighters’ & Rescue Squad Workers’ Service Award
Program. Members only. The amount the deceased firefighter contributed to
the fund will be given to the beneficiary in a lump-sum payment upon
death. Death benefits are payable to the spouse, or equally to the
children if no spouse survives. Program
not yet funded. Contact: Department VOLSAP
representative or the Plan Administrator --- (804) 267-3116. |
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Education Benefit - Children |
Undergraduate tuition and required educational and
auxiliary fees waived for children aged 16-25 at any public institution of
higher learning in Virginia. Contact: State Council of
Higher Education for Virginia, James Monroe Building, Ninth Floor, 101 N.
Fourteenth Street, Richmond, VA 23219 --- (804) 225-2611. |
|
Education Benefit - Spouse |
Same as for children, except for age restriction. Contact: State Council of
Higher Education for Virginia, as listed above. |
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Non-Profit or Private Organizations |
HEROES, Inc. Virginia Public Safety Foundation |
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Health Insurance |
Survivors eligible to receive state death benefits
also qualify for continued health insurance coverage paid in full out of
the state’s general fund. Spouse covered for life. Children covered
until age 21, age 25 if full-time student, or longer if mentally or
physically disabled. Contact: Office of the
Comptroller, Department of Accounts, James Monroe Building, 101 N. 14th
Street, Richmond, VA 23219-3684 --- (804) 225-3038. |
Public Safety Officers Benefit
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Public Safety Officers' Benefits (PSOB) Program |
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National
Fallen Firefighters Memorial Service
National
EMS Memorial Service
Commonwealth
of Virginia Fallen Firefighters Memorial Service
IAFF
Fallen Firefighters Memorial Service
Hampton
Roads Regional Fallen Firefighters Memorial Service
IAFF Fallen Firefighters Memorial Service
The names of all IAFF members who died in the Line of
Duty will be inscribed on the
IAFF Fallen
Fire Fighter Memorial. The IAFF
honors these Brothers and Sisters
annually during
a ceremony at the Fallen Fire Fighter Memorial Grounds in Colorado
Springs,
Colorado. The names all IAFF
members who die in the line of duty will be
published in
the LAST ALARM section of the International
Firefighter.
Memorial
Awards
Presidential
Medal of Valor for Public Safety Officers
(A maximum of ten medals will be presented each year)
Commonwealth
of Virginia Legislative Resolution
(Must be requested by General Assembly Representative)
IAFF
Martin E. Pierce Commemorative Line-Of-Duty Death Medal
IAFF Martin
E. Pierce Commemorative Line-Of-Duty Death Medal
In honor of fire fighters who die in the line of duty, the IAFF presents
the Martin E. Pierce
Commemorative Line-of-Duty Death medal to the family of
the deceased. In such cases, the
President of the deceased member's Local Union, or the
Local President's designee, is
responsible for notifying the IAFF as soon as possible
that a medal is required. The surviving
spouse or family member of all IAFF members killed in the
line of duty on or after the
August
5, 1990, passage of 1990 Convention Resolution 85 are eligible to receive an
IAFF
commemorative medal on behalf of all the members of the
IAFF at no cost. Affiliates wishing
to obtain a
commemorative medal for the spouse or family members of an IAFF member who
was killed in the line of duty prior to the date of
adoption of Resolution 85, must make such a
request through the International General President.
Upon approval, the Local may purchase
a medal from the IAFF at cost.
Medal
Presentation
The method of presenting the medal to the surviving spouse or family
member of
a
deceased IAFF member depends upon the individual circumstances, the wishes of
the
family, and the advice of the local union.
It is incumbent upon the Local Union to communicate with the deceased's
family to determine whether it is appropriate to present the medal during the
funeral service, during the memorial service, at graveside, or at some other
location or later date. It is
the responsibility of the Local Union President, or the Local President's
designee, to contact the IAFF as soon as possible to inform of the decision on
when the medal will be presented.
Depending
on the circumstances, the wishes of the family, and input from the Local Union,
the medal will be presented to the family of a deceased IAFF member by the Local
President or other designated officer of the deceased member's Local.
In the case of multiple line-of-duty fatalities, the Local Union
President or the Local President's designee, may request that the medal
presentation be made by the IAFF General President, the IAFF General
Secretary-Treasurer, or the respective IAFF District Vice President for that
local.
Order
of Entitlement
In
the event of a line-of-duty death, the surviving spouse is entitled to receive
the
commemorative medal.
• In the event that
the spouse is deceased or otherwise unavailable, the child of
the deceased member is entitled to receive the medal.
• In the event of
multiple children, the oldest child is the recipient.
• If there is
neither a surviving spouse or child, the parent(s) of the deceased
member receives the medal.
• If there is no
spouse, child, or parent, the oldest sibling of the deceased
member would receive the medal.
Items that will be requested by the PSOB program, Commonwealth of Virginia, Virginia State Police and Workers’ Compensation Commission.
1.
Line of Duty
Death Claim Benefits Form
2. Decedent's Full Name
3. Decedent's Date of Birth
4. Date of Injury
5. Date of Death
6. City, State, Address of injury
7. City, State, Address of Death
8. Witnesses to Injury (Interview)
9. Witnesses to Death (Interview)
10. Name and Address of Spouse and
Social Security Number
11. Interview of Spouse
12. Name and Address of Previous Wife
(wives) and SS#
13. Name , Address, Age, and SS# of
All Children
14. Interview of Work Supervisor
15. Death Certificate (Feds - 5
Certified Copies)
16. Birth Certificate - Decedent's
(Feds - 5 Certified Copies )
17. Birth Certificate - Spouse (Feds
- 3 Certified Copies)
18. Birth Certificate - All Children
(Feds - 3 Certified Copies)
19. Marriage Certificate (Feds - 1
Certified Copy)
20. Last Will and Testament (Feds - 1
Certified Copy from Attorney)
21. Statement (Bill) from Funeral
Home (Feds - 5 Certified)
22. Medical Examiner's Report (Feds -
3 Certified Copies)
23. Autopsy Report (Feds - 3
Certified Copies)
24. Toxicology Report must include
carbon monoxide levels (Feds - 3 Certified Copies)
25. Emergency Room Report
26. Hospital Discharge Summaries (If
more than one, each time in hospital for injury or illness)
27. Pre-employment Physical and
Decedent's Last Physical
28. Workmen's Compensation Reports
29. Interview of Decedent's Doctors
30. Children's College Information
(If attending)
31. Accreditation of Children's
College (Feds)
32. Monetary Funding of College
(Feds)
33. Fire Investigation Report or
Investigative Summary
34. Work Schedule
35. Radio Log
36. Authorization for Release of
Information
37. Divorce Decrees, if needed
38.
Separation
Papers from Attorney, if needed
39. Copy of certified list of
volunteer firefighters as recorded by the Clerk of the Court (if serving with a
volunteer fire dept.)
40. Contract, ordinance or Resolution
recognizing unit as part of safety program with Government Agent(s) Signature
(applies to fire and rescue squad services)
41. Copy of Training Records
42. Payroll Records
43. Employee Primary Care Physician
Records
44. Department Roster
45. Copy of Fire Incident Report
46. Copy of EMS Report
47. Copy of Fire Casualty Report
48. Interview Personnel on Scene
49. Certified Copy of any Prenuptial
Agreements
50. Copy of Obituary
You
will need a minimum of 12 certified copies of the death certificate.
Employee
Emergency Contact Information
The information that you provide will be used ONLY in the event of your serious injury or death in the line of duty. Please take the time to fill out this form completely and accurately because the data will help the department take care of your family and friends.
Please discuss this form, your will and any other wishes you may have
with your family. Should your family decide to deviate from your wishes the
department will honor your family's wishes to the extent possible.
PERSONAL INFORMATION
EMPLOYEE NAME ______________________________________________________
(Last)
(First)
(Middle)
HOME ADDRESS________________________________________________________
(Street)
(Apt #)
________________________________________________________________________
(City/County)
(State)
(Zip Code)
DAYTIME PHONE NUMBER EVENING PHONE NUMBER
__________________________ _________________________
EMPLOYMENT INFORMATION
DIVISION_____________________ DUTY ASSIGNMENT___________
SHIFT ASSIGNMENT___________ RANK________________________
DATE OF EMPLOYMENT_________________________________________________
(Month)
(Day)
(Year)
Family and friends you would like the department to contact. Please list in the order you want them contacted. If needed, provide additional names on the back of this sheet.
NOTE: If the contact is a minor child, please indicate the name of the adult to contact. The adult will be contacted prior to notifying the minor child. No minor child will be notified without the proper adult supervision.
CONTACT INFORMATION
NAME__________________________________________________________________
RELATIONSHIP TO EMPLOYEE___________________________________________
________________________________________________________________________
HOME CONTACT INFORMATION_________________________________________
(Address)
________________________________________________________________________
(City/County)
(State)
(Zip Code)
HOME PHONE NUMBER_________________________________________________
WORK CONTACT INFORMATION_________________________________________
(Employer)
________________________________________________________________________
(Employer Address)
EMPLOYER PHONE NUMBER____________________________________________
PAGER NUMBER___________________________
CELL PHONE NUMBER______________________
SPECIAL CIRCUMSTANCES, i.e. Health, Age, etc.
________________________________________________________________________
________________________________________________________________________
CONTACT INFORMATION
NAME__________________________________________________________________
RELATIONSHIP TO EMPLOYEE___________________________________________
________________________________________________________________________
HOME CONTACT INFORMATION_________________________________________
(Address)
________________________________________________________________________
(City/County)
(State)
(Zip Code)
HOME PHONE NUMBER_________________________________________________
WORK CONTACT INFORMATION_________________________________________
(Employer)
________________________________________________________________________
(Employer Address)
EMPLOYER PHONE NUMBER____________________________________________
PAGER NUMBER___________________________
CELL PHONE NUMBER______________________
SPECIAL CIRCUMSTANCES, i.e. Health, Age, etc.
________________________________________________________________________
_______________________________________________________________________
CONTACT INFORMATION
NAME__________________________________________________________________
RELATIONSHIP TO EMPLOYEE___________________________________________
________________________________________________________________________
HOME CONTACT INFORMATION_________________________________________
(Address)
________________________________________________________________________
(City/County)
(State)
(Zip Code)
HOME PHONE NUMBER_________________________________________________
WORK CONTACT INFORMATION_________________________________________
(Employer)
________________________________________________________________________
(Employer Address)
EMPLOYER PHONE NUMBER____________________________________________
PAGER NUMBER___________________________
CELL PHONE NUMBER______________________
SPECIAL CIRCUMSTANCES, i.e. Health, Age, etc.
________________________________________________________________________
________________________________________________________________________
LIST THE NAMES AND DATE OF BIRTH OF ALL OF YOUR CHILDREN.
NAME__________________________________________________________
DOB:___________________________________________________________
NAME__________________________________________________________
DOB:___________________________________________________________
NAME__________________________________________________________
DOB:___________________________________________________________
NAME__________________________________________________________
DOB:___________________________________________________________
LIST THE DEPARTMENT MEMBER(S) YOU WOULD LIKE TO ACCOMPANY THE NOTIFICATION TEAM TO MAKE PROPER NOTIFICATION.
NAME__________________________________________________________________
NAME__________________________________________________________________
LIST ANYONE ELSE YOU WANT TO HELP MAKE THE NOTIFICATION:
(i.e. Your Minister)
NAME__________________________________________________________________
RELATIONSHIP TO EMPLOYEE___________________________________________
TITLE/RANK____________________________________________________________
HOME CONTACT INFORMATION_________________________________________
(Address)
________________________________________________________________________
(City/County)
(State)
(Zip Code)
HOME PHONE NUMBER_________________________________________________
WORK CONTACT INFORMATION_________________________________________
(Employer)
________________________________________________________________________
(Employer Address)
EMPLOYER PHONE NUMBER____________________________________________
PAGER NUMBER___________________________
CELL PHONE NUMBER______________________
The following information will be used to assist your family and friends to make the proper notifications, benefit procurement, and family planning assistance. It is especially difficult for a family to remember where important papers may be located when notified of a serious injury or death, this is why we ask that you disclose this information in this format.
RELIGIOUS PREFERNCES
RELIGION_______________________________________________________
PLACE OF WORSHIP______________________________________________
(Name)
_________________________________________________________________
(Address)
_________________________________________________________________
(City/County)
(State)
(Zip Code)
PHONE NUMBER__________________________________________________
DO YOU WANT THEM NOTIFIED? YES NO
MILITARY SERVICE
ARE YOU A VETERAN OF THE U.S. ARMED SERVICES? YES NO
IF SO, WHAT BRANCH?____________________
LAST RANK HELD_________________________
IF YOU ARE ENTITLED TO MILITARY FUNERAL, DO YOU WISH TO HAVE
ONE? YES
NO
DO
YOU WISH TO HAVE A FIRE SERVICE FUNERAL?
YES
NO
DO YOU HAVE A WILL? YES NO
IF YES, LOCATION OF YOUR WILL_______________________________________
IF YOU DO NOT HAVE A WILL AND WOULD LIKE TO SPECIFY SPECIAL FIRE SERVICE ARRANGEMENTS PLEASE USE THE ATTACHED FORM AT THE END OF THE DOCUMENT.
FIRE SERVICE FUNERAL: PLEASE LIST IN YOUR WILL THOSE PERSONNEL YOU WISH
TO ACT AS PALL BEARERS AND HONORARY PALL BEARERS, LIST THE PIECE OF APPARATUS
YOU WISH TO BE CARRIED ON, AND IN WHICH UNIFORM YOU WISH TO BE
BURIED.
IF YOU DO NOT LIST PALL BEARERS THE HONOR GUARD WILL PERFORM THESE
FUNCTIONS AT THE REQUEST OF YOUR FAMILY.
MASONIC RIGHTS
ARE YOU A MASON? YES NO
DO YOU WISH TO HAVE MASONIC RIGHTS AT YOUR FUNERAL? YES NO
IF YES, LODGE NUMBER_______
LODGE LOCATION______________________________________________________
LODGE PHONE NUMBER_________________________________________________
FUNERAL ARRANGEMENTS
DO YOU HAVE A FUNERAL HOME PREFERENCE? YES
NO
IF YES, NAME_________________________________________________
LOCATION____________________________________________________
(Address)
______________________________________________________________________________________________
(City/County)
(State)
(Zip Code)
PHONE NUMBER________________________________________________
HAVE YOU PREVIOUSLY PURCHASED CEMETERY PLOTS?
YES NO
IF YES, NAME OF CEMETERY ____________________________________
LOCATION______________________________________________________
(Address)
_________________________________________________________________________________________________
(City/County)
(State)
(Zip Code)
PHONE NUMBER__________________________________________________
INSURANCE INFORMATION
PLEASE LIST ANY INSURANCE POLICIES YOU HAVE?
INSURANCE COMPANY________________________________________________
AGENT NAME_________________________________________________________
POLICY NUMBER______________________________________________________
LOCATION OF POLICY_________________________________________________
INSURANCE COMPANY________________________________________________
AGENT NAME_________________________________________________________
POLICY NUMBER______________________________________________________
LOCATION OF POLICY_________________________________________________
INSURANCE COMPANY________________________________________________
AGENT NAME_________________________________________________________
POLICY NUMBER______________________________________________________
LOCATION OF POLICY_________________________________________________
INSURANCE COMPANY________________________________________________
AGENT NAME_________________________________________________________
POLICY NUMBER______________________________________________________
LOCATION OF POLICY_________________________________________________
PLEASE LIST ANY SUPPLEMENTAL INSURANCE YOU HAVE?
INSURANCE COMPANY________________________________________________
AGENT NAME_________________________________________________________
POLICY NUMBER______________________________________________________
LOCATION OF POLICY_________________________________________________
PLEASE LIST YOUR MEMBERSHIP
IN FIRE SERVICE, RELIGIOUS, OR COMMUNITY ORGANIZATIONS THAT MAY PROVIDE
ASSISTANCE TO YOUR
FAMILY:_________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
PLEASE LIST ANY SPECIAL REQUESTS YOU MAY HAVE:
FORM UPDATED AS OF:____________________________________________
(Month)
(Day)
(Year)
SPECIAL
FIRE SERVICE ARRANGEMENTS
ACTIVE PALL BEARERS
NAME____________________________________
NAME____________________________________
NAME____________________________________
NAME____________________________________
NAME____________________________________
NAME____________________________________
HONORARY PALL BEARERS
NAME____________________________________
NAME____________________________________
NAME____________________________________
NAME____________________________________
NAME____________________________________
NAME____________________________________
APPARATUS TO BE UTILIZED AS HEARSE
ENGINE___________________________________
MEDIC____________________________________
SPECIAL HYMNS
NAME OF HYMN____________________________
NAME OF HYMN____________________________
SPECIAL SONGS TO BE PLAYED
TITLE/ARTIST________________________________
TITLE/ARTIST________________________________
ATTIRE YOU WOULD LIKE TO BE BURIED IN:
YOUR DEPARTMENT NAME
HERE UNIFORM
YOUR DEPARTMENT NAME
HERE DRESS UNIFORM
MILITARY UNIFORM
CIVILIAN CLOTHES
SPECIAL REQUEST:
YOU ARE MORE THAN
WELCOME TO MAKE A COPY OF THIS PACKET AND THE DEPARTMENT ENCOURAGES YOU TO DO SO
AND TO KEEP THIS WITH YOUR OTHER IMPORTANT PAPERS.
REMEMBER TO UPDATE
THIS FORM WHEN
NECESSARY.