Agency Contact Information Form

A vital first step in the WADEPS onboarding process is having the right contact information for each agency.

Please complete the short survey below at your earliest convenience. Only one response per agency is needed.

The information will be used for communications regarding the use-of-force reporting requirements under Chapter 10.118 RCW to the state-appointed data custodian, the Washington State Data Exchange for Public Safety (WADEPS).

General Agency Information

Agency Name(Required)

Please enter the full name of your agency.

Name of Chief/Sheriff/Agency Head(Required)

First Last

Title

Agency Main Website(Required)

Please copy the address from your web browser.

Agency Main Phone(Required)

Agency Mailing Address

Street Address Address Line 2 City ZIP / Postal Code

Contracted Services

Contracted Services(Required)

My agency receives dispatch services from another law enforcement agency.

My agency provides dispatch to another agency or agencies.

Not applicable

What agency do you receive dispatch services from?(Required)

Please use the agency’s full name.

General Data Use Agreement(Required)

The DUA governs how data provided to the system is shared, used, and made available to the public and ensures submitted data mirrors data held independently by participating agencies and their respective dispatch centers.

Which entity do you anticipate will have signature authority for the general DUA?

My agency.

The agency providing services to us.

Yet to be determined.

How many agencies do you provide dispatch services for?(Required)

List the agencies you provide dispatch services for:(Required)

Please include the full name of each agency.
Separate multiple agency names with a comma.

Dispatch Information

Name of your dispatch center or Public Safety Answering Point (PSAP):

WADEPS Point(s) of Contact

WADEPS Primary Agency Point of Contact (APOC)(Required)

Please enter the name of the commissioned officer who will serve as the first point of contact for WADEPS communications and who will be responsible for assigning reporting permissions in the online WADEPS Use of Force Reporting Tool for your agency.

First Last

APOC Title(Required)

APOC Email(Required)

APOC Phone(Required)

Would you like to provide a secondary APOC?

Optional. A secondary APOC will receive information from WADEPS as provided to the primary APOC. For example, a secondary point of contact may be appropriate for agencies who receive contracted PSAP services and/or for agencies who will be assigning reporting responsibility to a non-commissioned staff member.

Yes

WADEPS Secondary Agency Point of Contact (APOC)(Required)

First Last

Secondary APOC Title(Required)

Secondary APOC Email(Required)

Secondary APOC Phone

Thank you for your time and attention.

Survey completed by:(Required)

My email address(Required)

Name

This field is for validation purposes and should be left unchanged.