Health and Welfare Information   Salvation Army
BC EDS Operations   Emergency Disaster Services
    British Columbia
NTS 212 TSA
 

Health and Welfare Information Request Form

  Person making the inquiry
  First Name {var T01_First_Name_req}   Last Name {var T02_Last_Name_req}
  Address: {var T03_Address}   City {var T04_City}
  Province {var T05_Prov}   Post Code {var T06_Poscode}
  Email Address {var T09_Email_Address_req}   Phone/Mobile {var T08_Telephone_req}
           
 
  Person whom the inquiry is about
  First Name {var T10_Target_Firstname_req}   Last Name {var T11_Target_Lastname_req}
  Address {var T12_Target_Address}   City {var T13_Target_City}
  Province {var T14_Target_Prov}   Postal Code {var T15_Target_Postcode}
  Email Address {var T16_Target_Email}   Tel. Number
{var T17_Target_Telephone}
Cell Phone {var T18_Target_cellphone}
         
  Additional information about the person:
  {var T19_Comments}
   
 
  RADIO OPERATOR ONLY
 
Relay Operator:  {var RelayOp}   Rcvd:  {var RcTime1}   All times are in 24 Hr format.
Radio Operator:  {var RadioOp}   Rcvd:  {var RcTime2}  Sent:  {var SentTime1}
         
Version 1.1     {var Contactname}