New Jersey EMS Task Force Incident Management Team - EMS MACC
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SIMULATED DEPLOYMENT 2017 NJEMSTF MEMBER AVAILABILITY
Use this form to report your resource as available for deployment for SIMULATED DEPLOYMENT 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
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OP1: Friday 9/8 0800-1700
OP2: Satuday 9/9 0800-1700
OP3: Sunday 9/10 0800-1700
OP: Friday - Saturday 0800 - 0800
OP: Saturday - Sunday 0800 - 0800
OP: Friday 0800 - Sunday 1700
Members can do strictly Daytime Operations on each day.
Members can do a 24 hr deployment.
Members can stay from Friday morning until Sunday afternoon.
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
*
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