NJ EMS Task Force - Incident Management Team - EMS MACC
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Asset Status Board
SEPTEMBER 2016 - NJEMSTF MEMBER AVAILABILITY
Use this form to report your resource as available for HEIGHTENED AWARENESS for SEPTEMBER 2016 activities
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Indicates required field
Name
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First
Last
What if your PRIMARY NJEMSTF Module
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Select your PRIMARY
Air Operations
Communications
Leader
Logistics
MACS/IMT
Medical Operations
Physician Response
Safety
Staging
Technology
MSED
Planning
Finance / Administration
Cert Level
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Select One
EMT
Paramedic
Physician
Other (Mention in Comment section)
Who is your host/sponsoring agency?
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If responding to a SPECIFIC ORDER REQUEST, enter Order Reference Number here.
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Email
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Phone Number
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Primary Position Requested
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Secondary Position Requested
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AVAILABILITY - 9/2016 Heightened State
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OP: Monday 9/19 1900-0700
OP: Tuesday 9/20 0700-1900
OP: Tuesday 9/20 1900-0700
OP: Wednesday 9/21 0700-1900
OP: Wednesday 9/21 1900-0700
OP: Thursday 9/22 0700-1900
OP: Thursday 9/22 1900-0700
OP: Friday 9/23 0700-1900
OP: Friday 9/23 1900-0700
Are you available for the full deployment period?
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YES
NO
Only Portion
If you are deploying as part of staff on a NJEMSTF ASSET, please state what unit here
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Comment
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Emergency Contact Name
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First
Last
Emergency Contact Number
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By clicking SUBMIT below, you verify that you are placing your availability for the DEPLOYMENT period you listed; that you understand you will may be held or housed in a CAMP or Staging Area to be determined; you understand that while the work hours you request may be honored, there are times work hours are extended to meet operational needs; you verify that your sponsoring agency has given you permission to participate in this deployment; that no deployment is authorized until you receive direct Deployment Orders from NJEMSTF Planning; and that reimbursement availablilty has not been determined for this deployment.
Submit
After Action Survey - NJ PAPAL DEPLOYMENT