OREGON  Declaration of Emergency    

  To: Governor, State of Oregon
  Through: Director, Office Oregon Emergency Management

  From:: {var PubOff} 

   1. Name of County: {var County}   

  2. Type of Incident:  {var Type}

  
3. Beginning Date and Time of Incident: {var BegTime}        

  4. Incident is: {var EventEnd}              Ending Date/Time: {var EndTime} 

  5. Description of Problem and Type of Assistance Needed

 
{var Problem}

  6. Initial Assessment of Damage, Number of Injuries - Deaths  
 
{var Initial}

  7. List of Actions Pending or Taken by County and/or other Local Governments

{var Actions}

  8. Request Date and Time -  Form was Filled Out:  {var DateTime}   

  9. Name of Authorizing Official (s): 
  {var Auth}

Note: An initial SITREP Report, separate from this form, will be sent as soon as possible.
                                                            Winlink Senders Call  {var MsgSender}            {var Templateversion}