STATE OF WASHINGTON
               EMERGENCY WORKER DAILY ACTIVITY REPORT    Ver 4.1

 County in Which Mission Took Place     Mission # 
 Mission Name        Date From      Date To  

   Unit Name      Address   

Indicate Actual Incident Check In and Out Times		 Date
 Date
  Date

                		Page  Of 
#   Emergency Worker Name Card # Time
 In                    Out		 Time
 In                   Out		 Time
In                  Out		 Total
 Hours		 Round Trip
Miles  
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

 Total Personnel        Total Hours       Total Miles  
                                              

 Name and Title Of Verifying Authority       Phone #  
           THIS FORM NEEDS TO INDICATE FULL NAME & TITLE OF LOCAL EMERGENCY MANAGEMENT DIRECTOR / COORDINATOR OR SHERIFF'S DEPUTY 

 
 Comments 
 
                                                                                                  EMD-078 (Rev. 08/2017-Winlink)