Mobile Reporter - NJ EMS Task Force - Incident Management Team - EMS MACC

NJ EMS Task Force - Incident Management Team - EMS MACC

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EMSTF Mobile Reporter
(Replaces Digital Sandbox Mobile Indicator as of 8/15/16)

FOR OFFICIAL USE ONLY by members of the EMS Task Force Support Group and NJ County OEM/EMS Coordinators & Deputies.
IP Addresses are tracked for all reports submitted.

EMSTF Mobile Reporter

* Indicates required field

Completed By: *

Phone Number *

Reporting agency *

Report Type *

Incident Location *

Line 1

Line 2

City

State

Zip Code

Country

Description/Notes: *

Photo Upload - No PHI info *

Max file size: 20MB

Upload File *

Max file size: 20MB

Attach File, if sending reports such as completed ICS214 Unit logs, etc.

EMSTF Assets Effected *

ASAP01 - UHNJ (Essex) ASAP02 - North Bergen (Hudson) ASAP03 - Union ASAP04 - Morris ASAP05 - RWJBH (Middlesex) ASAP06 - Englewood (Bergen) ASAP07 - Wayne FAS (Passaic) ASAP08 - Shark River Hills (Monmouth) ASAP09 - MONOC ASAP10 - Virtua (Camden) ASAP11 - AtlantiCare (Atlantic) ASAP12 - Lanoka Harbor (Ocean) ASAP13 - Bergen Co. ASAP14 - Clinton (Hunterdon) ASAP15 - Montclair (Essex) ASAP16 - Brick PD/EMS (Ocean) ASAP17 - AtlantiCare (Atlantic) ASAP18 - West Milford (Passaic) ASAP19 - Gloucester EMS ASAP20 - Rutgers EMS (Middlesex) ASAP Flemington Rescue (MSU495) ASAP JCMC ASAP McCabe ASAP Meadowlands (EMS1) ASAP Somerset County (97Special Ops 2) ASAP West Milford ASAP Weehawkin Communications Support Trailer - North Brunswick (Middlesex) EMS Command Center - North Brunswick (Middlesex) GEN56 w Light - North Brunswick GEN65 w Light - RVREMS/Edison Gator - Central SOV (Neptune) Gator - North SOV (UHNJ) Gator - South SOV (Cooper) HAZTAC1 - Elizabeth Fire/EMS 73 HAZTAC2 - RVREMSC/Edison LOGS2 - Elizabeth FD/EMS (Union) LOGS5 - UHNJ (Essex) MAB01 - Elizabeth (Union) MAB02 - Shark River Hills (Monmouth) MAB03 - Jersey City FD (Hudson) MAB04 - Valley Hospital (Bergen) MAB05 - Cedar Knoll EMS (Morris) MAB06 - Atlantic Highlands Keport (Monmouth) MAB07 - Rutgers (Middlesex) MAB08 - Essex County Sheriff (Essex) MAB09 - McCabe (Hudson) MAB10 - Newark FD (Essex) MAB11 - Wayne FAS (Passaic) MAB12 - AtlantiCare (Atlantic) MAB13 - Bergen EMS Training Center (Bergen) MAB14 - Gloucester EMS (Gloucester) MAB15 - Middlesex Co (North Brunswick) MAB16 - Middlesex Co (JFK EMS) MAB17 - Somerset Co (Somerville RS) 12 Patient MCRT Type 3 - Mt Laurel (Burlington) MCRT Type 3 - Cherry Hill (Camden) MCRT Type 3 - Gloucester MCRT Type 3 - Inspira (Salem) MCRUxx - MCRU01- Newark (UHNJ) MCRU02- Jersey City FD (Hudson) MCRU03- MCRU04- MCRU05 - RWJBH (Middlesex) MCRU06 - Brick (Ocean) MCRU07 - Monmouth Sheriff (Monmouth) MCRU08 - Elizabeth FD (Union) MCRU09 - Englewood Hospital (Bergen) MCRU10 - MCRU11 - St Josephs Hospital (Passaic) PrimeMover 26 - Montclair (Essex) PrimeMover 139 - UHNJ (Essex) PrimeMover Monroe (Middlesex) REHAB - Clinton (Hunterdon) REHAB - McCabe (Hudson) SAMT-Atlantic (Galloway) SAMT-Bergen1 (NJSEA EMS) SAMT-Bergen2 (Hackensack) SAMT-Essex1 - UHNJ (H) SAMT-Essex2 - Montclair SAMT-Gloucester (Deptford) SAMT-Hudson (JCMC) SAMT-Hudson1 (North Bergen EMS) SAMT-Hunterdon 1 SAMT-Hunterdon 2 (Clinton) (H) SAMT-Mercer (Capital) SAMT-Middlesex (Monroe) SAMT-Monmouth1 SAMT-Monmouth2 (Hazlet) SAMT-Ocean (Toms River) SAMT-Somerset SAMT-Sussex (Lakeland) SAMT-Union (Linden FD) (H) SOV-Central (Neptune) SOV-Central Trailer (Neptune) SOV-North (UHNJ) SOV-North Trailer (UHNJ) SOV-South (Cooper) SOV-South Trailer (Cooper) Suburban Hunterdon (Car865) Suburban Middlesex (MCOEM) Suburban Middlesex (RWJBH) Suburban Monmouth (SRH) Suburban Mercer (Capital - OUT OF SERVICE) Suburban Ocean (Toms River) Suburban Somerset TSU North (UHNJ) TSU South (AtlantiCare) IAT Communications Steinman IAT Safety Contreras IAT Staging Buchanan IAT Leader Grembowiec IAT Central Planner IAT South Planner IAT Logistics Planner Gabriel IAT Med Ops Mellish MODULE - COMMS/TECH MODULE - FINANCE/ADMIN MODULE - HELIBASE MODULE - LOGISTICS MODULE - MACS/IMT MODULE - MEDOPS MODULE - STAGING MODULE - SAFETY MODULE - TRAINING Tow Vehicle - AtlantiCare 602 (Atlantic) Tow Vehicle - Holy Name (Bergen) Tow Suburban - Hunterdon OEM Tow Vehicle - Montclair (Essex) Tow Vehicle - UHNJ (Essex) Tow Vehicle - UHNJ (Essex) Tow Vehicle - McCabe 102 (Hudson) Tow Suburban - Capital (Mercer) Tow Vehicle - NBFARS A5 (Middlesex) Tow Vehicle - NBFARS A10 (Middlesex) Tow Vehicle - RVREMS (Middlesex) Tow Suburban - Toms River PD/EMS 510 (Ocean) Tow Vehicle - Wayne FAS (Passaic) Tow Suburban - Somerset Tow Vehicle - Elizabeth 74 (Union) Tow Suburban- Middlesex OEM Tow Suburban - RWJBH (Middlesex) Tow Suburban - SRH (Monmouth) Tow Vehicle - Union OEM (Union) SIM Trailer - UHNJ (Essex) Gatekeeper - Neptune (Monmouth) Gatekeeper - AtlantiCare (Atlantic) Gatekeeper - Brick PD/EMS (Ocean) Leader North - Steve Cicala Sr (Englewood) Leader North - Mike McCabe (McCabe) Leader Central - Louis Sasso (RWJBH) Leader Central - Michael Bascom (Neptune) Leader South - Lou Raniszewski (AtlantiCare) Leader South - Michael Divito (Deptford) State EMS Coordinator - Ken Christensen (OEMS) MSED1 - AMERCO MSED2 - AMERCO MSED MSU - AMERCO MSED BRIV - AMERCO MSED Supply 1 - AMERCO MSED Supply 2 - AMERCO O2 GEN - Newark 02 GEN - Jersey City 02 GEN - Bergen 02 GEN - Hudson 02 GEN - Middlesex O2 GEN - Union (Truck) O2 GEN - Passaic O2 GEN - Morris O2 GEN - Essex

Select all units effected by this report. If a non-TF asset, or not listed, please list full description in Description/Notes box.

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Telephone

1-973-878-9911

eFax

1-302-340-6881

Email

njemsmacc@njemstf.org

After Action Survey - NJ PAPAL DEPLOYMENT