WASHINGTON STATE RESOURCE REQUEST MESSAGE    (ICS 213RR WA)     Vers 8.4.3

                    
 * REQUESTOR *

1. Mission # & Incident Name     2. Requesting Agency  

3. Date & Time  (mm/dd/yy - 0000)      4. Requester Tracking # 
5. Resource Request
SHADED AREAS TO BE FILLED BY LOGISTICS/FINANCE SECTIONS
a. Qty     b. Kind  c. Type  d. Detailed item description and/or of task to be accomplished: (Vital characteristics, brand, specs, experience, size, etc.) and, if applicable, purpose/use, diagrams and other info.    Needed Date/Time    
e. Requested
f. Estimated
g. Cost
6. Personnel/Support Needed:  (Driver/Fuel Etc.)
  7. Duration Needed    
8. Requested Delivery/Report Location
 9. Delivery/Reporting Location POC   (Name and Contact Info) 
 
10. Suitable Substitutes &/or Suggested Sources  
 11. Priority : Life Saving    Incident Stabilization     Property Preservation
12 . a. Have all commercial resources been exhausted: Yes No
       b. Have all local resources been exhausted: :     Yes No
       c. Have all mutual aid resources been exhausted: Yes No


 
13. Requester willing to provided funding : Yes     No
if "No" Explain:
14. Requested by Name/Position & phone/email:       15. Request Authorized by: 
 * LOGISTICS *
16. EOC/ECC Logistics Section Tracking # 
 17. Name of Supplier/POC  (Phone/Fax/Email) 
 
18. Notes (Be Brief)    
               
Approval Signature of Authorized Logistics Representative:    20. Date & Time: (mm/dd/yy - 0000)
 
21. Order Placed by:   ORD UNIT   PROC UNIT   Other  
 
22. Elevate to State? YES NO  23. State Tracking #      24. Mutual Aid Tracking #         
 * FINANCE *
25. Reply/Comments from Finance  
26. Finance Section Signature:                         27. Date/Time (mm/dd/yy - 0000) 
 

                     
Original to Documentation Unit    Copies to Logistics Section, originating ESF/Agency, & Finance & Administration Section.