| 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: |
|
| Overal Status: |
|
| Requestor Name: |
Phone:
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| FAX: |
Email:
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| Resource Requested: |
|
| Detailed Description: |
{var Input16} |
| Request Specific Resources |
| Description/Kind:
Size/Type: Quantity: |
| |
| Delivery Location Name: |
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| On-site Point of Contact POC: |
POC Phone Number:
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| POC Email: |
|
| 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? |