New Jersey EMS Task Force Incident Management Team - EMS MACC
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LOGISTICS MODULE
NJEMSTF members can respond to their 2018 Equipment Issued Survey electronically. Please complete ALL items. If no, enter no or n/a
2019 NJEMSTF Member PPE Survey
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Indicates required field
Last Name
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First Name
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Agency
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Module - Position
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Region
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Select One
UASI-North
North
UASI-Central
Central
South
Helmet
Helmet Manufacture
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Helmet Serial Number
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Helmet Manufacture Date
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Turnout Coats and Pants
Turnout Manufacture
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Turnout Coat Serial Number
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Inside of the jacket liner should be serial number
Turnout Coat Manufacture Date
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Turnout Pant Serial Number
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Turnout Pant Manufacture Date
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Gloves
Gloves Manufacture
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Gloves Serial Number
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Gloves Size
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Select one
Small
Medium
Large
Extra Large
Boots
Boots Manufacture
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Boots Size
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Boots Serial Number
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Boots Manufacture Date
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APR
APR Manufacture
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APR Size
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APR Serial Number
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APR CBRN Expiration Date
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APR P100 Expiration Date
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APR RZ Dusk Mask (Yes or No)
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Select one
YES
NO
APR RZ Dusk Mask Size if yes
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Eye Protection
EyePro Manufacture
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EyePro Serial Number
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EyePro Manufacture Date
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Notes or Comments
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Submit
2018 Member Issued Personal Protective Equipment (PPE) Survey
Greetings Team! Please take some time and fill out this survey about your issued PPE. The Logistics Officers and I are working on some ideas to possibly replace end of life (EoL) PPE or issue new to members that have none. The first step is to get a better idea of what we have throughout the state. All of the information that is requested can be found inside of your PPE. If it is unreadable just answer “unreadable”. If the PPE does not have the requested info just answer “N/A”. Please have this form completed and returned to me by the end of day September 23rd 2018. You may complete here online or Email a
paper form
to me at gabrieas@uhnj.org. If you have any questions just give me a call (973) 868-6563. Thank you in advance.
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Indicates required field
Team Member
*
First
Last
Host Agency Name
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Assigned Module
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Email
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Phone Number
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Region
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Select One
UASI - NORTH
North - Non UASI
Central
South
Statewide
County
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Helmet Issued? If yes, Serial Number, Manufactured Date & Color
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Gloves? If yes, size and brand
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Boots? If yes, Size & Brand
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MSA Millennium Air Purifying Respirator (APR)? If yes, Serial Number, Size & Cartridge Expiration Date
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Eye Protection? If yes, Brand
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Hearing Protection? If yes, Brand
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Turnout Jacket? If yes, Serial Number, Manufactured Date & Size
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Turnout Pants? If yes, Serial Number, Manufactured Date & Size
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Meter? If yes, Type, Serial Number and Date
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Any module specific equipment issued to you:
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Submit
After Action Survey - NJ PAPAL DEPLOYMENT