WASHINGTON STATE RESOURCE REQUEST    (WebEOC Format)     Vers 2.2  

                
 
                        Request For Assistance or Resources                                              Blue boxes are required fields
Date (mm/dd/yyyy):   Time (hh:mm):
Creator:
Requesting Agency:
County: City / Tribe:  
Requester Tracking #
State Tracking #   Generated by State
Priority:   Set by Logistics or Operations Only
Overal Status:
Requestor Name: Phone:     (XXX-XXX-XXXX)
FAX: (XXX-XXX-XXXX)    Email:     (email@xxx.xxx)
Resource Requested:   Enter a one or two word description (ie: Generator or Debris Removal)
Detailed Description:
Detailed description of Capability Needed (What do you want to accomplish?)
Request Specific Resources
Description/Kind:     Size/Type:     Quantity:  
 
Delivery Location Name:
On-site Point of Contact POC: POC Phone Number:     (XXX-XXX-XXXX)
POC Email:
format example: 08/05/2015 / 1500
Required delivery (Date and Time):   (Enter date and time needed. ASAP is not an answer.)
Duration Needed:
Delivery Needed: Yes   No
Address:   (Street, City, Zip)
Description using landmark or
LAT/LON:
Yes   No Have all local resources been exhausted
or predicted to be exhausted in the near
future?
Yes   No Has mutual aid been exhausted or
predicted to be exhausted in the near
future?
Yes   No Have all commercial resources been
exhausted or predicted to be exhausted
in the near future?
Yes   No Is the originating jurisdiction/agency
willing to pay for the assistance?