Resource
Qty
Unit
Primary POC Name:
Primary POC Phone
Secondary POC Name:
Secondary POC Phone
Date:
Date:
Date:
Request Accepted Date:
Request Rejected
Detailed Item Description
Time:
Reason/Justification:
Resource Details
Time:
Submitted By (Name):
Time:
Logistics or Command
FOR INTERNAL USE ONLY:
Incident/Facility Name: COVID-19 Response
15. Resource Req #:
EOC POC Name/Phone/Email:
Approver Name: Time:
Delivery Location/Address:
Coordinating Instructions:
Email:
Alternate Phone
Email:
Alternate Phone
Androscoggin County ICS 213 RR
Requestor
Requestor Name/Organization:
Requestor Phone/Email: