Incident Name:
Priority
• When do you need this request fulfilled? o 0-4 hours o 4-8 hours o 8-12 hours o 12-36 hours o Longer than 36 hours
Justification • Does the county or local jurisdiction have the ability to contract for these resources? o Yes o No
• Have you exhausted all mutual aid options in the surrounding counties? o Yes o No
• Additional justification for the requested resource(s): Justification Examples: Local jurisdiction does not have this resource... All existing resources have been contracted out... Surrounding counties are also impacted... No mutual aid is available...
Requesting Jurisdiction • Requester Agency: • Operational Area:
Requested Resources • Resource Name: • Quantity Requested (ea): • Detailed Resource Description: (Vital characteristics, brand, specs, experience, size, etc.) • Is an operator needed for this resource?
• Request Summary (Why is this resource needed and what will it do):
• Actions taken on this request so far (what have you done to obtain the resource on your own)?
Requester Information • Requester First & Last Name: • Requester Email: • Requester Phone: • Requester Title:
Delivery Information • Recipient First & Last Name: • Delivery Recipient Email: • Delivery Recipient Phone: • Delivery Recipient Title: • Delivery Recipient Entity Name: • Delivery Location: • Delivery Notes:
EMMA FORM 1B EMMA RESOURCE REQUEST (REV. 9/2018) Form Info
EMMA #: (Generated in WebEOC/CalEOC by Requesting Jurisdiction)
Request Date/Time:
Providing Jurisdiction Authorization: (The following signature of the Providing Jurisdiction indicates a good-faith effort to ensure the EMMA resource(s) listed on this form is qualified to fulfill the request and is available for deployment. It is understood that this form does not constitute a contract with the Requesting Jurisdiction. Mutual aid extended under the EMMA Plan shall be without reimbursement unless otherwise established in a separate pre/post-event agreement between the Requesting and Providing Jurisdictions.)
Print Name and Title: Signature: