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Department of Fire Services - Student Awareness of Fire Education & Senior Safe Grant Application

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1
EXECUT IVE OF F ICE OF PUBL I C
SAFE T Y & SE C U RIT Y
DE PA RTME N T OF FIR E SE RVI C E S
STUDENT AWARENESS OF FIRE EDUCATION &
SENIOR SAFE
GRANT APPLICATION FY 2020
Charles D. Baker Thomas A. Turco, III
Governor Secretary of Public Safety & Security
Peter J. Ostroskey
State Fire Marshal
DEPARTMENT OF FIRE SERVICES
P.O. BOX 1025 – STATE ROAD
2
STOW, MASSACHUSETTS 01775
Telephone: (978) 567-3380
Fax: (978) 567-3199
Table of Contents
Purpose ......................................................................................................................................... 3
Eligibility ...................................................................................................................................... 3
Funding ........................................................................................................................................ 3
Tier Allocations .......................................................................................................................... 4
Submission and Deadline Requirements .......................................................................... 4
Reporting Requirements ........................................................................................................ 5
Required Information .............................................................................................................. 5
School-based S.A.F.E. Program Grant Application ....................................... 7-9, 11-13
Senior SAFE Program Grant Application .......................................... 7-8, 10-11, 14-15
Planning Grant Application ................................................................................. 7-8, 11-13
Signature Page for Online Submission ........................................................................... 16
Joint Agreement ............................................................................................................... 17-19
School-Based S.A.F.E. Program Score Sheet .................................................................. 20
Senior SAFE Program Score Sheet .................................................................................... 22
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
3
Purpose: The purpose of the school-based S.A.F.E. and Senior SAFE grants are to support
programs that:
School-based S.A.F.E.
o Provide fire and life safety education to school aged children in order for them to
recognize the dangers of fire, including the fire hazards that smoking related
materials pose.
o Create school partnerships working together to reach the goals and objectives of
the state’s Health Education Curriculum Frameworks and the Common Core of
Learning through teaching key fire safety behaviors.
Senior SAFE
o Provide fire and life safety education to seniors in order for them to recognize the
dangers of fire, poisoning, falls and other medical emergencies including the fire
hazards that smoking related materials pose.
o Create community partnerships and collaborate with the purpose of improving fire
and life safety in the homes of seniors.
Priorities: Applications funded through these grants shall address the following priorities:
Activities that address fire and health hazards of smoking related materials.
Activities/programs that address the key fire and life safety behaviors addressed in the
Massachusetts Public Fire and Life Safety Education Curriculum Planning Guidebook.
Activities/programs that prevent and reduce fire and burns.
Have trained fire and life safety educators providing education, training and
programming in their communities.
Eligibility: Fire departments are eligible to apply for a Senior SAFE grant, school-based Student
Awareness of Fire Education (S.A.F.E.) grant, or S.A.F.E. planning grant, and/ or Senior SAFE
grant per the following guidelines:
• All municipal fire departments/ fire districts may apply for the Senior SAFE grant.
• Cities or towns whose fire department or fire district had a S.A.F.E. program grant in any
of the Fiscal Years 2015-2019 is eligible to apply for the School-based S.A.F.E. program
grant. Fire departments with ongoing programs may utilize grant resources to enhance
their current efforts by adhering to the S.A.F.E. program’s guidelines.
• Fire departments or fire districts that have not had an active school-based S.A.F.E.
program in any of the Fiscal Years 2015-2019 are eligible to apply for a planning grant.
Planning Grants: School-based S.A.F.E. planning grants will be awarded based on available
funds. It is anticipated that $1,500 will be the award for planning grants. Planning grants can be
awarded once, and then fire departments/districts must apply for program grants.
Funding: Departments shall use funds to adopt and carry out fire and life safety education in
their community. One-half of the budget of a school-based S.A.F.E. grant must be devoted to the
core school-based program. Senior SAFE is primarily for the education of the senior population.
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
To be eligible for this grant, the fire department must partner with a community organization that
works directly with seniors.
School-based S.A.F.E. Grants Tiers
Tier
Amount
Population
1
$2,600
0-4,999
2
$3,500
5,000-14,999
3
$4,100
15,000-29,999
4
$5,200
30,000-49,999
5
$6,500
50,000-89,999
6
$10,200
90,000-499,999
7
$13,600
Over 500,000
Senior SAFE Grant Tiers
Tier
Amount
Population
1
$1500
0-4,999
2
$1800
5,000-14,999
3
$2000
15,000-29,999
4
$2200
30,000-49,999
5
$2400
50,000-89,999
6
$2600
90,000-499,999
7 $2800
Over 500,000
Grant funding is based on a tiered amount. Fill out the budget page with the requested
amount determined by your population.
Program Period:
The grant award funds shall be expended within 12 months of the date of the award letter and the
required reports submitted within 14 months of the award letter.
Submission and Deadline Requirements:
Submit an ORIGINAL and ONE COPY of your completed application ONLY for each grant,
unless submitting online. Applications must be received no later than 5:00 PM on Friday,
September 27, 2019 by mail or hand delivery to:
Department of Fire Services
P.O. Box 1025, State Road
ATTN: 2019
S.A.F.E. Program
Stow, MA 01775
If sending this by mail we suggest you request a return receipt. If emailed, we will email you that
we received the application. No extensions beyond the aforementioned deadline will be granted.
Faxed applications are NOT acceptable. A “wet signature” must be mailed to DFS in
addition to the online submission. Please email all applications to
Cynthia.Ouellette@mass.gov.
THE APPLICATION IS AVAILABLE ON-LINE ON OUR WEBSITE AT www.mass.gov/dfs
4
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
5
Reporting Requirements:
Fiscal Year 2020 Funds
The time period to spend Fiscal Year 2020 S.A.F.E. and Senior SAFE grant funds will expire on
December 31, 2020. At that time, grantees will be able to apply for a one time 6-month extension
to spend those funds, which shall include a plan on how the extended funds will be utilized. At
the close of the single extension all unexpended funds must be returned to the Commonwealth
and a Final Budget Worksheet submitted.
Fiscal Year 2019 S.A.F.E. Funds
Communities have until December 31, 2019 to spend their Fiscal Year 2019 funds. Year end
reports will be due by January 31, 2020. Communities may request a one-time six-month
extension with their completed Year-End Report.
Unexpended Grant Fiscal Year 2018 Funds and Prior Years
In accordance with guidance from the Office of the State Comptroller, the time period to spend
Fiscal Year 2018 (or any prior year) balance has expired. Any unexpended Fiscal Year 2018 (or
prior year) funds must be returned to the Department of Fire Services. Please coordinate with
your financial official to arrange for the return of these funds to DFS as soon as possible.
Compliance Review
The Department of Fire Services will conduct compliance reviews to a number of communities
to ensure that communities are complying with the requirements of the S.A.F.E. Program and to
provide technical assistance.
Contact:
For assistance in the conceptualization or formulation of your program or application, please
contact Cynthia Ouellette via email at Cynthia.ouellette@mass.gov or by telephone at (978)
567-3381.
Required information: Departments must submit the following information: (If departments are
applying for both grants, submit only one copy of the Community Data and Demographics
sheets.)
School-based S.A.F.E.:
1. Community Data Sheet (Page 7)
2. Community Demographics (Page 8)
3. School-based Mission Statement (Page 9)
4. Budget Formulation Worksheet (Page 11)
5. Budget and Program Narrative (Page 12-13)
6. Online Submission Signature Page (Page 16)
7. Copy of student evaluation tool
8. Copy of instructor/educator evaluation tool.
Senior SAFE:
1. Community Data Sheet (Page 7)
2. Community Demographics (Page 8)
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
6
3. Senior SAFE Mission Statement (Page 10)
4. Budget Formulation Worksheet (Page 11)
5. Budget and Program Narrative (Pages 14-15)
6. Online Submission Signature Page (Page 16)
Planning grant: See page 13
1. Community Data Sheet (Page 7)
2. Community Demographics (Page 8)
3. Budget Formulation Worksheet (Page 11)
4. Budget and Program Narrative (Page 12-13 excluding the evaluation question)
5. Your program must have one school-based and one community-based activity.
6. Online Submission Signature Page (Page 16)
Joint Grants: See page 12
1. Community Data Sheet for each fire department or district (Page 7)
2. Community Demographics for each fire department or district (Page 8)
3. Signed Joint Agreement (Page 17-19)
4. This in addition to the application requirements listed above.
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
7
Community Data Sheet
For Joint Grants Each Community Must Complete a Separate Community Data Sheet
Preparer Information
Name
Title
Organization Name
Address
City
State
Zip
Business Phone
Business Fax
Email
FDID Number
Category: School-Based S.A.F.E. □
Senior SAFE □
School AND Senior SAFE □
Type of Grant Requested: Program Grant □ Planning Grant □ Joint Grant □
Signature of Authorizing Official
______________________________________________________________
Fire Department, Authorizing Official and Date
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
8
Community Demographics
Total Community Population
Source: Department of Fires Services from
2010 U.S. Census.
Public
K-12 School Enrollment
Pre-K and K
Grades 1 and 2
Grades 3 and 4
Grades 5 and 6
Grades 7 and 8
Grades 9 and 10
Grades 11 and 12
Total
Number of Schools (by type):
Public
Private
Elementary
Middle
High
Total
Population 65+
Other High-Risk Population Targeted
(specify)______________________
Total
S.A.F.E. Educator Training
Name of Lead S.A.F.E. Educator who has
completed MFA Public Fire and Life Safety
Educator Training
Name of Lead S.A.F.E. Educator who will
complete MFA Public Fire and Life Safety
Educator Training by June 30, 2020.
0
0
0
0
0
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
9
S.A.F.E. Mission Statement
School- Based S.A.F.E. Program
The following represents the core mission of the S.A.F.E. program:
The Student Awareness of Fire Education (S.A.F.E.) program is a fire prevention
education program designed to equip elementary, intermediate, and high school students with
skills for recognizing the dangers of fire, including the fire risks posed by smoking-related
materials. The program utilizes specially trained firefighters to teach fire and life safety
education. Many of the firefighters are trained emergency medical technicians who have seen
the catastrophic health effects of smoking-induced illnesses.
The S.A.F.E. educator serves as a role model for impressionable youth while providing
students with firsthand knowledge of the dangers associated with fire, age-appropriate
information on preventing and surviving those fires that occur, and through a core school-
based program, affect a change in the behavior and the safety of the community at large.
The S.A.F.E. Program is designed to create a partnership between the school and fire
department. Working jointly to reach the goals and objectives of the state’s Curriculum
Frameworks and the Common Core of Learning, firefighters teach the Key Fire Safety Behaviors
using the Massachusetts Public Fire and Life Safety Education Curriculum Planning Guidebook
and model teamwork for the students.
Please sign and date below to acknowledge your community’s pledge to adhere to the S.A.F.E.
mission by striving to achieve its goals and objectives.
__________________________________________________________
Designated Fire Official Print
Signature/Date
__________________________________________________________
School Dept. – Designated Official Print
Signature/Date
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
10
S.A.F.E. Mission Statement
Senior Safe Program
The following represents the core mission of the Senior S.A.F.E. program:
The Senior SAFE program is a fire prevention education program designed to improve
the fire and life safety of older adults in the Commonwealth of Massachusetts through
education that addresses the unique fire risks for this age group. Some of the risks include
smoking, home oxygen use, cooking, electrical and heating dangers. The program utilizes
specially trained firefighters to teach fire and life safety education. Many of the firefighters are
trained emergency medical technicians who have seen the catastrophic health effects of
smoking-induced illnesses and the dangers of fire associated with home medical oxygen use.
Senior SAFE aims to improve the safety of older adult homes. Programs may include the
installation of smoke and carbon monoxide alarms, testing and replacing batteries in these
devices, the installation and checking of house numbers, installing high-end heat limiting
devices on stoves, in-hood stove fire extinguishers, nightlights, and other fall prevention
interventions where needed to provide safety for the at-risk older adult population in the
community. In addition to installing safety devices, education specific to their circumstances is a
crucial component of improving the safety of older adults at home.
The Senior SAFE educator serves as a community leader who can provide firsthand
knowledge of the dangers associated with fire, age-appropriate information on preventing and
surviving those fires that occur, and affect a change in the behavior of older adults.
The Senior SAFE Program is designed to create a partnership between older adults and
fire departments through established providers of senior support services such as Councils on
Aging, Senior Centers, Visiting Nurse Associations, or other similar agencies.
Please sign and date below to acknowledge your community’s pledge to adhere to the S.A.F.E.
mission by striving to achieve its goals and objectives.
__________________________________________________________
Designated Fire Official Print
Signature/Date
__________________________________________________________
Senior Agency Partner – Designated Official Print
Signature/Date
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
Budget
Category
Description
Town:___________________________________
School-
Based
Budget
Amount
$________
Senior
S.A.F.E.
Budget
Amount
$________
Salary
To defray personnel costs incurred as a result of a commitment to S.A.F.E., such
as replacement costs of firefighters dedicated to S.A.F.E. program initiatives.
Compensation paid to employees engaged in activities affiliated with this grant
may include regular salary, replacement salary, overtime, overtime replacement
and other salary benefits
Training
To provide training of personnel in any nationally recognized fire safety
curriculum. Training courses and seminars sponsored by the Department of Fire
Services are available. Typical expenses in this category include tuition, S.A.F.E.
related in-state travel or lodging, and meal expenses. This includes training
conducted by the fire department which should be listed under personnel costs.
Equipment
Costs associated with the purchase and installation of equipment affiliated with
this grant. To purchase or lease equipment to support and enhance S.A.F.E. efforts
such as televisions, DVD players, and camcorders. For the Senior SAFE Program,
funds may be used to purchase smoke alarms, carbon monoxide alarms,
replacement batteries, tools such as drills and step ladders for installation, high-
end heat limiting devices for stoves, in-hood stove top fire extinguishers, house
numbers, nightlights, and other similar fall prevention devices.
Materials
& Supplies
Costs associated with any materials or supplies affiliated with the grant including:
program curriculum, workbooks, DVDs, videos, handouts, classroom supplies, T-
shirts, bumper stickers, and other educational or promotional materials.
Other
To purchase miscellaneous and/or incidental items related to the successful
implementation of the S.A.F.E. program.
Total
The total should be the total amount you are eligible to apply for in your tier.
Balance of Unexpended Fiscal Year 2018 Funds $________________________
(Any Unexpended funds should be returned to DFS)
_______________________________________________________________________________
Chief's signature Date
11
$ 0.00
$ 0.00
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
12
Budget Narrative for School-Based S.A.F.E. Grants
Fully explain how are you going to spend your S.A.F.E. grant? What you will spend your grant
on (personnel costs, supplies, etc.)? Identify how at least 50% of your school-based grant will be
spent educating students. Include the attached budget sheet for both the school-based and
Senior SAFE grants.
Identify your audience. Fully explain who you will be teaching. (Include all grades, number of
classrooms you intend on visiting, number of visits to each classroom, etc.)
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
13
Program Narrative For School-Based S.A.F.E. Grants
Give a full description of the following:
What are the Key Fire Safety Behaviors you will address during the year? Include how you will
address the fire risk of smoking materials (cigarettes, pipes, lighters, matches, etc.)
What curricula will you be using?
What instructional methods will you be using?
What other community events will you be sponsoring or involved with?
What is your plan to evaluate your program? Be specific. Attach both the student and teacher
evaluation forms you will use to this application. If you are using the 3
rd
, 6
th
or 10
th
grade
evaluations, attach only the cover sheet.
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
14
Budget and Program Narrative for Senior SAFE Grants
Fully explain how you are going to spend your Senior SAFE funds.
What is your plan to address older adult fire safety? (Home visits, senior center visits,
installations of smoke alarms or other safety devices) Explain.
If you intend to provide training for other SAFE educators and/or non-fire department partners
please list here.
What are the Key Fire Safety Behaviors you will address during the year? List at least 3.
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
15
Fully explain how you will work with your partnering agency to deliver fire safety information.
What instructional methods will you use?
Fully explain your plan to keep track of smoke/CO alarm installations or home visits.
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
16
For Online Submission Only
Signature page must be mailed to: Department of Fire Services
P.O. Box 1025, State Road
Stow, MA 01775
ATTN: 2019 S.A.F.E. Program
I hereby acknowledge that I have reviewed and approved the above grant and budget
application and the information provided herein is, as of this date, true and accurate.
____________________________________________________________________
Signature – Chief of the Fire Department Date
For the School-based S.A.F.E. grant:
Please sign and date below to acknowledge your community’s pledge to adhere to the S.A.F.E. mission by striving to
achieve its goals and objectives.
___________________________________________________________________________________
Signature - Designated Fire Official Date
___________________________________________________________________________________
Print Name Title
___________________________________________________________________________________
Signature - Designated School Department Official Date
___________________________________________________________________________________
Print Name Title
For the Senior SAFE Grant:
Please sign and date below to acknowledge your community’s pledge to adhere to the S.A.F.E. mission by striving to
achieve its goals and objectives.
___________________________________________________________________________________
Signature - Designated Fire Official Date
___________________________________________________________________________________
Print Name Title
___________________________________________________________________________________
Signature - Designated Senior Agency Official Date
___________________________________________________________________________________
Print Name Title
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
17
Joint Agreement Between
The Department of Fire Services
And
The S.A.F.E (Student Awareness of Fire Education) Grant Recipients
Senior SAFE Grant Recipients
(To be completed only by Communities/ Districts submitting joint applications)
This agreement is entered into by and between the Commonwealth of Massachusetts,
Department of Fire Services, State Road, Stow, Massachusetts and the City/Town of
____________________________, as principal acting on behalf of itself and the City/Town(s)
of ____________________________, ____________________________,
____________________________, beneficiaries and regional grant recipients. This agreement is
for:
Student-based S.A.F.E.
Senior SAFE
Both
In exchange for mutual promises contained herein, as good and sufficient consideration,
the receipt and sufficiency of which are hereby acknowledged, the parties are agreed as follows:
TERMS AND CONDITIONS
I) The Department
A) The Department of Fire Services shall provide S.A.F.E. grant monies, in the amount
of $ __________________, in accordance with the funding formula provided for in the regional
SAFE grant application, incorporated herein by reference.
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
18
B) This money is intended to be used for public fire education services to be provided by
the principal for itself and all its beneficiaries. The total grant award as provided, above, and
shall be the total sum award for the principal and its beneficiaries as determined by the SAFE
grant formula provided in the grant application.
II) The Principal and Beneficiaries
A) The principal and its beneficiaries agree to enter into any necessary agreements
necessary to effectuate the purpose of the grant award and the terms of this agreement, including
but not limited to, the execution of contracts related to the grant.
B) The principal and beneficiaries, expressly warrant that they will abide by the terms of
the S.A.F.E. grant and this agreement in exchange for the grant award monies provided for and
referenced herein. The beneficiaries will “forgo funding” for their respective communities in
exchange for their receipt of services as provided herein.
So Agreed:
For the Department of Fire Services:
______________________________ _____________________
Peter J. Ostroskey, State Fire Marshal Date
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
19
For the Principal: City/Town of _______________________________________
________________________________ ________________________
Designated Signature Authority Print Name and Title
______________________________
Date
For the Beneficiaries:
City/Town of: ______________________
________________________________ _________________________________
Designated Signature Authority Print Name and Title
_______________________________
Date
City/Town of: _______________________
_______________________________ __________________________________
Designated Signature Authority Print Name and Title
_______________________________
Date
City/Town of: _______________________
______________________________ __________________________________
Designated Signature Authority Print Name and Title
________________________________
Date
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
20
Required Information
School-Based S.A.F.E. Grant
Part 1
This Plan must include all of the
following:
Yes No Partial
Information
Comments Met All
Requirements
Demographics
PFALSE Trained member
Name:
Or: Name of member to
complete PFALSE by June 30,
2020
___________________________
Past Year-End reports complete
MFIRS Complete
Budget page signed by the chief
or signature page included
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
21
Required Information
School-Based
S.A.F.E. Grant
Part 2
Yes No Partial
Information
Comments Met All
Requirements
Documented School
Partnership: Signed by
the chief and
superintendent of
schools
Part 3 Narratives
Does the plan include
al descriptive narrative
which includes ALL of
the following
components:
1. Explanation of
how 50% is spent
on students.
2. How the grant
money is going to
be spent.
3. Who is the
audience?
4. Grades and
students visited.
5. Key fire safety
behaviors
including the
dangers of
smoking and
smoking materials.
6. What curricula will
be used?
7. What instructional
methods will be
used?
8. What is the plan
for both student
and teacher
evaluations.
9. Any community
activity?
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
22
Required Information
Senior SAFE Grant
Part 1
This Plan must include all of the
following:
Yes No Partial
Information
Comments Met All
Requirements
Demographics
PFALSE Trained member
Name:
Or: Name of member to
complete PFALSE by June 30,
2020
___________________________
Past Year-End reports complete
MFIRS Complete
Budget page signed by the chief
or signature page included
Fiscal Year 2020 School-based S.A.F.E. and Senior SAFE Program Grant Application
23
Required Information
Senior SAFE Grant Yes No Partial
Information
Comments Met All
Requirements
Part 2
Documented
Partnerships signed by
the senior agency
partner and the chief.
Part 3 Narratives
Does the plan include
al descriptive narrative
which includes ALL of
the following
components:
1. Plan to address
older adult fire
safety.
2. Training for non-
fire home visitors.
3. What Key Fire
Safety Behaviors
will be taught?
4. Description of
working with the
partnering agency.
5. What instructional
methods will be
used?
6. A plan to keep
records for
installations.
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