ICS-211 Check In Form GS17 VEHICLE

GOTHAM SHIELD 2017: ICS-211: ELECTRONIC CHECK IN FORM - VEHICLE

* Indicates required field

AGENCY NAME: *

County *

Vehicle ID *

State / License Plate # *

If BLS, Certified By: *

NJ OEMS NJSFAC Unalligned N/A

Select Vehicle Type *

Check only if NJEMSTF Member/Unit? *

YES

Agency Chief Officer Name *

Agency Email, if known: *

Name/Unit Leader *

First

Last

Certification Level, if appropriate *

Email *

Unit Leaders Phone Number *

Assignment, if known *

Time Checked In *

Total # Personnel: *

List Other Personnel on vehicle with Cert Levels if appropriate *

CHECK IN