Staging Area Change

STAGING MODULE

County EMS COORDINATORS can use this form to request a change or addition to a designated staging area. Please complete ALL items.

* Indicates required field

Person Making Request *

First

Last

Email *

County of Staging Area *

Change or Add? *

CHANGE ADDITION DELETION

Location of Staging Area (Name, Address, Zip, info) *

Ingress & Egress Route Instructions: *

Frequencies Utilized: *

Bathroom/Shelter Info: *

Site Security Provided By: *

Site Security Contact Info: *

Activation Process (Include regional/local dispatch center, name, phone number and directions) *

Submit