OREGON     Declaration of Emergency     Vers 7.2

  To: Governor, State of Oregon
  Through: Director, Office Oregon Emergency Management

  From:  

  TO  

  CC  
     If known, enter call or email of your DEC in CC.  
         
  1.  Name of County     

  2. Type of Incident 

  3. Beginning Date and Time of Incident    

  4. Incident is ?   If Incident has Ended - Enter End Date/Time  

  5. Brief Description of Problem and Type of Assistance Needed
  

  6. Brief Initial Assessment of Damage, Number of Injuries - Deaths  (No Victim Names)
 

  7. Brief List of Actions Pending or Taken by County and/or other Local Governments
  

  8. Request Date and Time - Form Filled Out   

  9. Name of Authorizing Official (s)  

Note: Send an initial SITREP Report, seperate from this form as soon as possible.
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