WASHINGTON
STATE RESOURCE REQUEST (WebEOC Format)
Vers 2.2
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Request For Assistance or Resources Blue boxes are required fields |
Date (mm/dd/yyyy): | Time (hh:mm):
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Creator: |
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Requesting Agency: |
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County: |
City / Tribe:
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Requester Tracking # |
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State Tracking # |
Generated by State |
Priority: |
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Overal Status: |
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Requestor Name: |
Phone:
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FAX: |
Email:
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Resource Requested: |
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Detailed Description: |
{var Input16} |
Request Specific Resources |
Description/Kind:
Size/Type: Quantity: |
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Delivery Location Name: |
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On-site Point of Contact POC: |
POC Phone Number:
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POC Email: |
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| format example: 08/05/2015 / 1500 |
Required delivery (Date and Time): |
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Duration Needed: |
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Delivery Needed: |
{var Input26} |
Address: |
(Street, City, Zip) |
Description using landmark or LAT/LON: |
{var Input28} |
{var Input29} |
Have all local resources been exhausted or predicted to be exhausted in the near future? |
{var Input30} |
Has mutual aid been exhausted or predicted to be exhausted in the near future? |
{var Input31} |
Have all commercial resources been exhausted or predicted to be exhausted in the near future? |
{var Input32} |
Is the originating jurisdiction/agency willing to pay for the assistance? |