Fillable Resource Request Form 213RR for Non-Medical Personnel (DSW) (County of Santa Clara)

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Resource Request Form 213RR for Non-Medical Personnel (DSW) (County of Santa Clara)

On average this form takes 13 minutes to complete

The Resource Request Form 213RR for Non-Medical Personnel (DSW) (County of Santa Clara) form is 3 pages long and contains:

  • 1 signature
  • 8 check-boxes
  • 44 other fields

Country of origin: US
File type: PDF

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County of Santa Clara
Emergency Operations Center (EOC)
Resource Request Form 213RR for Non-Medical Personnel (DSW)
COMPLETED BY REQUESTOR
1. Incident Name
2019 Novel Corona Virus (COVID-19)
2. Date Initiated
3. Time Initiated
4. Tracking Number
(Completed by OA EOC)
5. Requested By (name, agency, position, email, phone)
How to use the EOC Form 213RR
Purpose
The EOC 213RR is used to request non-mutual aid supplies, services,
personnel, teams, equipment, utilities, fuel, facilities, or any other resource or
incident management activity required from the Operational Area (OA.)
When to use
The Form 213RR may be used anytime during any Operational Period. If the
OA EOC is not activ
ated the Duty Officer will serve to coordinate the request.
Prepared by
Any EOC position or agency requesting resources from the OA
6. Prepared by (name, position, email, phone)
Approved by
(A) Executive or Supervising Official at requesting agency or (B) a Section Chief of the
requesting EOC or (C) Deputy County Exec
utive if request is from a County Department and is requesting
PPE.
Routed to
Logistics Section - SCC Resource Tracking Unit
Send signed form via email to: resourcetracking@eoc.sccgov.org
Filed with
Logistics Section Resource Tracking Unit / Planning Section
Documentation Unit
7. Approved by (name, position, email, phone)
Signature:
User Notes
The EOC is a last resort provider and you may be responsible for the cost of
the requested items. Please check that all pages and necessary fields
are completed. Page 1 is required for all requesters. Please be sure the
form has proper signatures for Approved By (box 7). The last page is
completed by the OA EOC.
Requesting Agency / EOC Section
REQUESTED RESOURCE DETAILS
8. Qty/Unit
9. Resource Description Note: See page 3 for providing
additional information for non-medical personnel requests.
10. Arrival (date/time) 11. Priority 12. Est’d Cost
Now
High
(0-4 hours)
Medium
(5-12 hours)
Low
(12+ hours)
13. Deliver to (name, agency, position, email, phone)
14. Location (address or lat./long., site type)
15. Substitute/Suggested Sources (name, phone, website)
16. Supplemental Requirements (include details in #17) 17. Special Instructions
Equipment Operator
Fuel
Fuel Type
Meals
Water
Lodging
Power
Maintenance
Other
Form 213RR
County of Santa Clara – Emergency Operations Center (EOC)
Last Revised: 12/8/2020
Page 1 of 3
click to sign
signature
click to edit
Disaster Service Activity
EOC Tracking #
Report to
Contact Number
Location to report
Date(s) to report
Schedule
Duration
Duties
Items to bring with you
Types of PPE provided
Amenities (ie break room,
lunch provided, etc)
If you have any questions regarding this request, please email the EOC personnel unit at
personnel@eoc.sccgov.org.
Thank you in advance for your help,
EOC Personnel Unit
TO BE COMPLETED BY ALL REQUESTORS
Last Revised: 12/8/2020
Page 2 of 3
County of Santa Clara
Emergency Operations Center (EOC)
Resource Request Form 213RR
COMPLETED BY OA EOC or DUTY OFFICER
OA EOC
Logistics
Section
18. Order Placed By
(name, position, agency, phone, radio, email)
19. Method of Procurement
(filled-in house, agreement, purchase, etc.)
20. Supplier Name / Point-of-Contact Information
(name, address, phone, fax, email)
21. Logistics Section Remarks
22. Logistics Section Chief Approval
(print and sign)
OA EOC
Fin/Admin
Section
23. Finance/Admin Section Chief Remarks and Approval
(print and sign)
Date/Time
OA EOC
Management
Section
24. EOC Director/County Executive Remarks and Approval
(print and sign)
Date/Time
OA EOC
Logistics
Section
25. Logistics Section Final/Demobilization Remarks
Date/Time
Form 213RR
County of Santa Clara – Emergency Operations Center (EOC)
Last Revised: 12/8/2020
Page 3 of 3
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Resource Request Form 213RR for Non-Medical Personnel (DSW) (County of Santa Clara)

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Completed 7 March 2021

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