CERT Online Profile
Thank you for your support of the CERT Program and you commitment to strengthen collaboration between community members and emergency responders
THIS PAGE IS TO REGISTER OFFICIAL CERT PROGRAMS ONLY, not to register individuals or individual teams sponsored by a local CERT Program. To be an official CERT Program the program must:
Be operated by a local emergency response organization such as your local Fire Department or Office of Emergency Management and endorsed by the Citizen Corps Council.
Conduct the CERT Basic Training Course and a CERT exercise at least once a year
Have a point of contact to be posted with other program information on the national CERT website
If you represent an official CERT Program, please continue. Some of the information you provide will be posted on the national CERT website. Your information will help individuals interested in CERT from your area to contact you, and allow you and your federal partners to share relevant information on CERT and other programs.
Your submission will be reviewed by the State CERT Manager or the Citizen Corps Program Manager before being posted. Once your CERT Program is approved, the CERT point of contact you identify below will receive a password to access your registration page and to update the posted content as needed. This point of contact will receive an automatic reminder to update the information every six months. Thank you for keeping the information on the website about your CERT Program current.
If you have any problems with completing this form or with updating your posted information, please contact us at [email protected]
Thank you again for your commitment to the CERT Program and the effort to train the community members and include them in supporting local emergency services
If you have any problems with completing this form, please contact us at [email protected].
Register / Edit CERT Program Profile
Start your submission by providing the following information, then hit Next:
CERT Program Name: *
Select Country: *
Select State *
Jurisdiction By: *
Available Assigned
One or more approved or pending CERT Programs report that they operate within the jurisdiction(s) you have selected. While you may continue with completing your CERT Program registration, we recommend that you contact your State CERT or Citizen Corps Program Manager and the local CERT Program(s) listed below to discuss coordinating your efforts. Click on any local CERT Program in the list to get their full contact information.
Click the "Continue with Registration" button below to continue your submission.
Overlapping CERTS
Rogers CERT
Lowell CERT Program
Baxter CERT Program
Boone County CERT
Siloam Springs Dept of Emergency Management
Baxter County Community Emergency Response Team
City of Bentonville CERT
You are required to establish a password for the system.
Password changes have the following restrictions:
* A password must be greater than 7 characters
* A password must be different than the current password
* A password must contain at least one digit or one of the following non-character values; @#$%^&+=-
Choose A Password: Confirm That Password:
The user [email protected] already has an existing pending submission.
Users may only work on one submission at a time.
Please log in and complete existing submission prior to creating a new request.
Please enter your email address (case sensitive) and password below.
Email__________________________
Password__________________________
Please note: This information will be publicly available on the CERT website.
Name, Address, & Description
CERT Name: *
Street Address: *
Street Address Cont.
City: *
Select Country: *
State: *
Postal Code: * - [extension]
Select Country*
Phone Number: * Ext:
CERT Web Site: http(s)://www.com
The sponsoring official of your CERT Program is a local elected leader, or the director or head of the agency which houses the program. This is typically the fire chief, police chief, sheriff or emergency manager of the jurisdiction, but may be another official.
Please note: This information will not be publicly available on the CERT website
Sponsoring Official Contact Information
First Name: *
Middle Initial:
Last Name: *
Title:*
Organization:*
Street Address: *
Street Address Cont.:
City: *
State: *
Postal Code: * - [extension]
Phone Number: * Ext:
Select Country: *
Email:*
In addition to posting a contact for your CERT Program, we would also like to include some more detailed information about your program. Your answers to the following will be posted on your program page on the CERT website.
General
Month and year your CERT Program started: select month, select year
Information last updated on XXXXXXX
Training
Some CERT Programs offer training to the general public, while others focus on particular groups to form teams who will work together in an incident.
Does your CERT Program hold classes for (check all that apply):
(Please be sure to update these figures whenever you complete a new training.)
As of today’s date, on average, how many times per year does your program conduct the CERT Basic Training Course?
Number of CERT classes that have graduated since program started?
General public / open classes
Specific neighborhood groups
Businesses
Critical Infrastructure Sectors (e.g., utilities, public transportation)
Government groups
Faith-based organizations
Teens/Youth
Colleges/Universities
People with disabilities
Military groups
Other __________
CERT in Action
Emergencies
How many times have your CERT responded in actual emergencies?
Please indicate the types of emergencies/disasters to which your CERTs have responded. (Check all that apply. Enter “None” in other for nothing.)
Earthquake
Wildland/urban interface fire
Flood
Excessive Heat
Hurricane
Landslide
Severe Thunderstorm
Tornado
Tsunami
Winter Storm
Other __________
Activities
What activities did your CERTs conduct? (Check all that apply.)
Residential / Neighborhood Checks
Medical intervention (triage or treatment)
Special Needs evacuation
Animal evacuation
Debris removal
Sandbagging
Processing food and other supplies
Traffic control/crowd management
Initial damage assessment
Basic search and rescue
Fire-related safety measures
Utility control / shut off
Staffing Emergency Operating Centers
Staffing shelters
Community Relations / Distribution of emergency information to the public
Other __________________________
What kinds of non-emergency functions do your CERT members participate in (Check all that apply):
Hazard / Threat assessments
Mitigation activities
Support for emergency planning (neighborhoods, schools, community)
Support for public safety at community events
Public Education and Outreach:
Emergency Preparedness
Fire Safety
Health Issues
Crime Prevention
Terrorism awareness
Home safety / prevention activities (winterizing homes; fire safety actions; crime prevention steps)
Other _________________________
Exercises
In how many of the following exercise categories has your CERT program participated? And how many CERT members participated in or supported the exercises?
Example: Your CERT Program has participated in 3 bio-terrorism exercise and 50 CERT members participated in each exercise for a total of 150 CERT exercise participants.
Type of Exercises Number of exercises? Number of CERT participants?
WMD/Terrorism _______ _______
Natural disasters _________ _______
Medical emergencies/bio-hazards/ Strategic National Stockpile
_________ ________
CERT specific exercises ________ _______
Does your program offer or require supplemental training levels after the basic CERT course?
If yes, please check all that apply and indicate if you any other organizations help to conduct these trainings (i.e. the Red Cross, ASHI, National Safety Council, NASAR, NFPA, ARRL) and include whether the training is offered online:
Additional training Provider Online (Y/N)
IS-100 Introduction to ICS
IS-200.a ICS for single resources
IS-700.a National Incident Management System
IS-800.b National Response Framework
Amateur Radio Operations
Animals in Emergencies
Community Relations
Additional CBRNE awareness
CPR
AED
Additional Damage assessment
Decontamination techniques
First Aid
Additional Incident Command System (ICS)
National Incident Management Systems (NIMS)
Shelter Operations
Additional Search and Rescue
Wildland/Urban Interface issues
Other ____________
Please note: Answers to the following questions will NOT be posted on the public website, but will be posted on the password protected section of the site. The information will be accessible only to other CERT Program and Citizen Corps Council points of contact. This data will help us all better understand how CERT is being implemented around the country and will help with growing and expanding the program.
Information last updated on XXXXXXXX
General Info
Does your CERT Program organize participants into identified teams who will work together in an incident? Y/N
Does your CERT Program conduct background checks on participants?
If yes, please indicate who is checked:
All program participants are checked
Only selected program participants are checked (e.g. team leaders).
Trainers
As of today’s date, how many trained instructors does your program have? _______
Where did these instructors receive their train-the-trainer instruction? Check all that apply:
State sponsored course
Locally sponsored course
Emergency Management Institute
Other ___________________
What background do your CERT instructors have? Check all that apply:
Fire service
Emergency Management
Law Enforcement
Volunteer organization
Other ____________________
Funding
How do you fund your program? (Check all that apply)
Federal funding
State funding (other than Federal grants allocated through the State)
Local jurisdiction funding
Private sector support
Foundation or philanthropy
General fundraising
Other ____________________
Staffing
Is your local CERT Program coordinator/manager paid or volunteer? Y/N
If paid, what approximate percentage of their time is allotted to CERT? XX%
Other info
Are your CERT Program / CERTs referenced in your jurisdictions Emergency Operations Plan or Comprehensive Emergency Management Plan? Y/N
Does your CERT Program have a written protocol for CERT Activations in emergencies in your jurisdiction? Y/N / Not sure
This is the principle point of contact for your CERT Program. This person’s name, phone number, and email address will be posted on the website so that people interested in CERT in your area can get involved. This is also the person who will receive information from state or federal partners. You may wish to create a generic email address for your program, such as [email protected]. This will allow multiple people to access the account and won’t fill up an individual’s email box.
Please note: This information will be publicly available on the CERT website. By submitting this form, the sender is confirming that the point of contact consents to have his or her name, phone number, and email address included in the online national CERT registry.
Contact Name & Address
First Name: *
Middle Initial:
Last Name: *
Title:*
Organization:*
Street Address: *
Street Address Cont.:
City: *
Select Country: *
State: *
Postal Code: * - 4 Digit Zip Ext.
Phone Extension
Phone Number: * Ext:
Email: *
Confirm Email: *
| File Type | application/msword |
| File Title | Thank you for your support of the CERT Program and you commitment to strengthen collaboration between community members and emer |
| Author | jenelle.gabriele |
| Last Modified By | FEMA EMPLOYEE |
| File Modified | 2009-08-24 |
| File Created | 2009-08-24 |