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:
COASTAL REGION RESOURCE REQUEST
Additional justification for the requested resource(s)
Requesting Jurisdiction Name:
Request Summary (Why is this resource needed and what will it do):