Residential Security Check Request

Submission of a Residential Security Check request will allow our Deputies to randomly check your home while you are away on vacation or other absences. If you have any questions or need assistance in completing the form, please call (410) 632-1111 ext. 2264 or 2263

There are two ways to have this form submitted.

1. Download the fillable PDF form and email it to

Sara Bradley at sbradley@co.worcester.md.us or Greg DeGiovanni at gdegiovanni@co.worcester.md.us

Residential Security Check Request PDF Form (PDF Form-Fillable)

2. Fill out the form below and submit it.

Security Check Request Form

Date of Birth *

Month

Day

Year

Please Provide as Much Information as Possible

Full Name *

Street Address *

Apartment Number

City *

State *

Zipcode *

Primary Phone *

Secondary Phone

Date Leaving *

Month

Day

Year

Time Leaving *

Hour

Minute

Date Returning *

Month

Day

Year

Time Returning *

Hour

Minute

Emergency Contact

Emergency Phone

Local Contact

Local Phone

Alarm Company

Vehicle(s) Present (Make, Model, Color, Tag) *

Animals Present at the Residence *

Authorized Person(s) *

Authorized Person(s) Phone Number

Authorized Vehicle(s) (Make, Model, Color, Tag) *

Key holder name and number or location of hidden key in order to gain access to residence for an immediate emergency (fire, water main break, intruder search, etc)

Please include any additional information that will assist our Deputies in checking your residence for unusual circumstances

Electronic Signature *

Click Here to Sign

I understand that by selecting the option above, I am providing a legal confirmation, under penalty of perjury, that the information provided on this form is accurate and true to the best of my knowledge.

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Math question * 3 + 1 =

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Worcester County Sheriff's Office

Proud to Protect, Ready to Serve

Matthew Crisafulli
Sheriff

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