Commendation Record Form

An official website of the City of Los Angeles

Use this form to recognize a Los Angeles Fire Department employee for exceptional service, professionalism, courage, or assistance provided to the community.

Submitting a Commendation
Please provide as much information as possible. Your comments may be forwarded to the appropriate supervisor and shared with the employee being recognized. Specific information regarding the incident, employee, unit, and circumstances is especially helpful.

Incident Information

Date of Incident *

Approximate Time

Incident / Event Type

Location of Incident *

Incident / Report Number

Employee / Unit Information

Employee Last Name

Employee First Name

Badge / Employee Number

Unit Number

Station

Unit Type

Reason for Commendation

Exceptional Service Professionalism Compassion / Courtesy Courage / Bravery Life-Saving Actions Community Service

Comments / Statement

Describe the service provided *

Reporting Party Information

Full Name *

Email Address *

Preferred Contact Method

By submitting this form, I certify that the information provided is accurate to the best of my knowledge. I understand that the information may be reviewed by Department personnel for the purpose of processing this commendation.

Electronic Signature *

LOS ANGELES FIRE DEPARTMENT

Commendation Record Form