OERS Incident Name & Number:

1. Requester:       2. Position:

3. Agency:     4. Jurisdiction:

5. Time, Date of Activation:

6. Reason for Activation:

7. Expected Duration of Activation:

8. Station Type: EOC Alt-EOC COOP Field Station

9. Call sign used for Voice is:           Call sign for Data is:

10. Station Physical Location:

11. VHF Frequencies

12. UHF Frequencies

13. HF Frequencies:
      Primary 3964 kHz +/- 5 kHz LSB Voice
      Secondary 7248 kHz +/- 5 kHz LSB Voice
      Data Frequencies as chosen by Winlink Express
      FEMA Channels 5330.5 kHz Dial Frequency USB Voice
            Local frequency:

14. Winlink (Amateur Service) E-Mail traffic will be monitored at least times per hour with acknowledgments.

       SHARES E-Mail traffic will be monitored at least times per hour with acknowledgments.

15. SHARES Calls in use:

16. Number of Operators at Station Location:

17. Other Information:

18. Authorizing Signature and Title:

19. Operator Issuing Message: