LOGS Change Form

LOGISTICS MODULE

County EMS COORDINATORS, ASSET Owners and NJEMSTF member can use this form to request a change or addition to the 2018 Master Asset Contact List. Please complete ALL items.

Master Contact 2018 Change/Addition/Delete Request Form

* Indicates required field

Change or Add? *

CHANGE ADDITION DELETION

Person Making Request *

First

Last

Email *

Phone Number *

Asset Category *

Type of Asset (As listed on chart) *

Host Agency Name *

Agency Contact Name *

Agency email *

Agency Contact Phone *

Dispatch Agency (24 hour) *

Dispatch 24 hour Phone *

Region *

County *

Asset Location *

Line 1

Line 2

City

State

Zip Code

Country

Notes/Comments *

Submit

LOGISTICS MODULE

Master Contact 2018 Change/Addition/Delete Request Form

Telephone

eFax

Email

After Action Survey - NJ PAPAL DEPLOYMENT