Form FEMA Form 142-1-1 FEMA Form 142-1-1 IPAWS Inventory

O.M.B. Control No. 1660-0106
Expires 12/29/2012

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
IPAWS INVENTORY SURVEY

PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this survey form is estimated to average three hours per response. The burden estimate includes the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the survey form. You are not required to respond
to this collection of information unless it displays a valid OMB control number. This collection of information is voluntary. Send comments regarding the accuracy of the burden estimate
and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW,
Washington, DC 20472, Paperwork Reduction Project (1660-0106) NOTE: Do not send your completed form to this address.
Executive Order 13407 signed on June 26, 2006 mandates that the Secretary of Homeland Security, who in turn designated FEMA, Integrated Public Alert & Warning System
(IPAWS) to “inventory, evaluate, and assess the capabilities and integration with the public alert and warning system of Federal, State, local, territorial and tribal (FSLTT)
public alert and warning resources.” For additional information regarding IPAWS, visit FEMA’s IPAWS website at: http://www.fema.gov/emergency/ipaws/

State:
EMA Name:
Mailing Address:

Survey Date:
Data Collector:
Contact Name:

Physical Address:

Title:
Work Phone:
Cell Phone:

Main Phone Number:
Fax Number:
Website:

Fax Number:
Email Address:
Description of Duties:

Facility Information
1 For routine, non-emergency purposes, how
does the EMA communicate with State,
County, and Federal Agencies?

Cell Phone
E-Mail
Fax
Incident Management
Software
Phone
Radio
Other:

3 Public alerts and notifications the EMA sends: None
All Hazards
All Hazards Except Weather
Law enforcement
Medical & public health
Pollution & environmental
CBRNE (HazMat)
EVAC/Shelter-in-place
Other:

2 For routine, non-emergency purposes, how does EMA currently
communicate within the agency and other local departments?

Cell Phone
E-Mail
Fax
Incident Management
Software
Phone
Radio
Other:

4 Who is authorized to send or initiate alerts on behalf of the EMA
jurisdiction?

No one
911 Dispatch Manager
EMA Director or designate
Fire Chief /Fire Marshall
Local Government Official
Health Director
Public Information Officer
Police/Sheriff
Other:

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FEMA Form 142-1-1

5 Can alerts be geo-targeted?

Yes
No

6 Can alerts be sent in a language other than English?
Do you have a need to alert in a language other than English?

Yes

No

Yes

No

What languages?
7 Is any type of special alerting done for the
disabled? (Seeing or hearing impaired)

Yes
No

Yes
9 Do you have an interest in using the
Commercial Mobile Alert System (CMAS –cell No
broadcast) when it becomes available?
11.1 Who is your commercial internet provider?

8 Do you have an interest in using IPAWS?
10 Do you have a logon to DM-OPEN or HazCollect?

11.2 What is your commercial internet type?

Yes
No
No
DM- OPEN
HazCollect
Unknown
Cable
DSL
Fiber
Microwave
Other:
Yes
No

12 Does the facility have a backup generator?

Yes
No

13 Does the facility have a UPS?
(Critical equipment on UPS or battery backup)

14 Does the facility have an alternate or backup
EOC?

Yes
No

15 Does the facility have a mobile EOC?

Yes
No

16 Can public alerts be sent from these
locations?

No
Mobile
Alternate/Backup

17 Are public alerts sent from alternate locations using the same
system as the primary location?

Yes
No

18.1 Number of Full Time EMA Staff:

18.2 Number of Part Time EMA Staff:

19 Facility Description :
(Multi-purpose building/area, older/newer building, reinforced, etc)

21.1 Does the facility not have any installed
systems?

Yes
No

20 Facility Security Description:
(Cameras, key card access, guards, etc)

21.2 Reason the facility has no systems:

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FEMA Form 142-1-1

Public Alert & Warning or Secondary & Supporting Systems
Complete this section for each system currently used in your facility.
Duplicate as needed. Include alerting, communication, and disaster
management software systems. Please use page 5 for systems that are
non-operational, avoided/unused, or desired/envisioned.
23.1 How was the system acquired?

24 Primary function of the system?

Provided by:
Federal Agency
State
Business/Industry
Volunteers Unknown
Purchased
Free Service
Unknown
Other:
Public Alerting & Warning
Situational Awareness
Disaster/Resource
Management
Communication
Collaboration

26 Components (All that apply) :

28 What devices transmit or receive alert, call,
etc.?
(Select all that apply)

Internet /Computer
Email
Cell Phone - Voice
Cell Phone - Text
Landline
Radio
TV
Sirens
Electronic Marquee/Signs
Pager
Fax
NOAA Weather Radio
Other:

22 System Name/Version:

23.2 If purchased, how was the system funded?
(Select all that apply)

Grant:
Federal
State
Regular Budget
Unknown
Other:

25 Secondary function of the system?

Public Alerting & Warning
Situational Awareness
Disaster/Resource
Management
Communication
Collaboration

27 How is the alert, call, etc. initiated?
(Select all that apply)

Computer (E-mail)
Computer (Software)
Fax
Hardware Activation
NWS or Outside Source
Phone
Radio
Website
Other:

System Comments:

Replacement, 20___
Termination, 20___
No
Unknown

29 What is the expected service life of the current
system? (Years)

30 Is the system scheduled for replacement or termination? Year?
Reason:

31 Does the system require regular updating?
If yes, how often?

32 Annual System Costs if known:
A. Annual Fee:
B. Annual Maintenance/Updating Costs:
C. Costs per use/call/minute for ETN/Satellite Phone Systems:

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FEMA Form 142-1-1

33 Does the system interface with systems within Yes
No
this jurisdiction?
Unknown

34 Does the system interface with systems in other
outside jurisdictions?

Yes
No
Unknown

35.1 Does the system have backup power?

Battery/Generator
Redundant System
No

35.2 If yes, does the backup come on automatically?

Yes
No

36.1 How often is the System unavailable?

Never
< 4 Hours
4-8 Hours
9-24 Hours
>24 Hours
Unknown

36.2 What are the reasons the System is
unavailable? (Select all that apply)

Software problem
Hardware problem
Connectivity
Power outage
Unknown
System Overload
System Maintenance
Other:

37 Type of facility where this system is available? EMA/EOC
(Select all that apply)
Alternate EOC
Mobile EOC
911-Dispatch
Anywhere:
 by Phone
 by Internet
 within Radio Coverage
Other:

38 Satisfaction Rating:
5 Completely Satisfied
4 Satisfied
3 Neutral
2 Unsatisfied
1 Completely Unsatisfied

39 What do you Like about the system?

40 What do you Dislike about the system?

41 How many hours are dedicated to monitoring? None
During business hours
When EOC is activated
24/7 EMA
24/7 Dispatch
Unknown
Initial:
43 Annual training hours per person:

42

How often is the system tested?

Remarks:

Refresher:

Remote (Off-site Personnel):

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FEMA Form 142-1-1

Non-operational, Desired/Envisioned, or Avoided/Unused
Complete this section for systems that the EMA currently has access
to but are not functional, avoided/unused, or are planned for future
procurement. Duplicate as needed for each system.
45 How was the system acquired?

47 Primary function of the system?

Provided by:
Federal Agency
State
Business/Industry
Volunteers Unknown
Purchased
Free Service
Unknown
Other:
Public Alerting & Warning
Situational Awareness
Disaster/Resource
Management
Communication
Collaboration

49 Components (All that apply) :

44 System Name/Version:

46 If purchased, how was the system funded?
(Select all that apply)

Grant:
Federal
State
Regular Budget
Unknown
Other:

48 Secondary function of the system?

Public Alerting & Warning
Situational Awareness
Disaster/Resource
Management
Communication
Collaboration
Computer (E-mail)
Computer (Software)
Fax
Hardware Activation
NWS or Outside Source
Phone
Radio
Website
Other:

50 How is an alert initiated?
(Select all that apply)

Desired Systems:
51 Why is system desired or
envisioned?
(Select all that apply)

Replace old/outdated system
Add new functionalities
Connect to/interoperate with other system
Other:

Remarks:

If the system is Avoided/Unused or Non-Operational:
52 Why is the system avoided/unused or not operational?

53 Why is system still in EMA if it is not operational?

54 Do you plan to use this system in the future?

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FEMA Form 142-1-1