WASHINGTON STATE RESOURCE REQUEST    (WebEOC Format)     Vers 2.2                   
 
Request For Assistance or Resources                     Blue boxes are required fields
Date (mm/dd/yyyy):   Time (hh:mm):
Creator:
Requesting Agency:
County: City / Tribe:  
Requester Tracking #
State Tracking #   Generated by State
Priority:
Overal Status:
Requestor Name: Phone:  
FAX:     Email:  
Resource Requested:
Detailed Description: {var Input16}
Request Specific Resources
Description/Kind:     Size/Type:     Quantity:  
 
Delivery Location Name:
On-site Point of Contact POC: POC Phone Number:  
POC Email:
format example: 08/05/2015 / 1500
Required delivery (Date and Time):
Duration Needed:
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?
      Winlink Express Sender:   {var MsgSender}