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Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service
Application Form
OMB Control # 0648-0419
Expires 06/30/2009
Community Information
County/City/Town
Population
Primary Point of Contact
Secondary Point of Contact
Name
Name
Office
Office
Title
Title
Mailing
Address
Mailing
Address
City
City
State; ZIP
State; ZIP
Phone
Phone
e-mail
e-mail
Guideline 1:
Location of 24-Hour Warning Point
Communications
Location of Emergency Operations Center
Verification Team General Notes:
Renewal Comments:
Date:
Initials:
Note: Please do not write in shaded areas.
Public reporting burden for this collection of information is estimated to average two hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other suggestions for reducing this burden to Donna Franklin, National Weather Service, 1325 East West Highway,
Room 14456, Silver Spring, MD, 20910.
Statement on confidentiality. Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected to a
penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of
information displays a currently valid OMB Control Number.
Page 1
Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service
Application Form
OMB Control # 0648-0419
Expires 06/30/2009
Guideline 2:
Warning Point
NWS Information Reception Equipment
# Required_____
# Verif_____
Verif
EOC
# Required_____
# Verif_____
NOAA Weather Radio (Required if in range)
NOAA Weather Radio (Required if in range)
NOAA Weather Wire (Subscription)
NOAA Weather Wire (Subscription)
EMWIN
EMWIN
Law Enforcement Teletype (LETS)
Law Enforcement Teletype (LETS)
Amateur Radio
Amateur Radio
Pagers* (Warning reception) ______
Pagers* (Warning reception)______
Television (Local network or cable TV)
Television (Local network or Cable TV)
Radio (AM/FM) - EAS reception
Radio (AM/FM) - EAS Reception
NAWAS
NAWAS
Internet (Subscription for alerts) ____________
Internet (Subscription for alerts) ____________
Commercial Data Service_________________
Commercial Data Service________________
Other*_________________________________
Other*________________________________
Other*_________________________________
Other*________________________________
Verif
List any additional capabilities on a separate sheet
*Capabilities needing explanation:
Verification Team Notes:
Renewal Comments:
Date:
Initials:
Note: Please do not write in shaded areas.
Page 2
Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service
Guideline 3:
Warning Point
Application Form
OMB Control # 0648-0419
Expires 06/30/2009
Local Weather & Water Monitoring Equipment
# Required_____ # Verif_____
Verif
EOC
# Required_____
# Verif_____
NOAA Weather Radio (Required if in range)
NOAA Weather Radio (Required if in range)
NOAA Weather Wire (Subscription)
NOAA Weather Wire (Subscription)
EMWIN
EMWIN
Law Enforcement Teletype (LETS)
Law Enforcement Teletype (LETS)
Amateur Radio
Amateur Radio
Pagers* (Warning reception) ______
Pagers* (Warning reception)______
Television (Local network or cable TV)
Television (Local network or Cable TV)
Radio (AM/FM) - EAS reception
Radio (AM/FM) - EAS Reception
NAWAS
NAWAS
Verif
List any additional capabilities on a separate sheet
*Capabilities needing explanation:
Verification Team Notes:
Renewal Comments:
Date:
Initials:
Note: Please do not write in shaded areas.
Page 3
Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service
Application Form
OMB Control # 0648-0419
Expires 06/30/2009
Guideline 4:
Warning Point
Local Warning Dissemination
# Required_____
# Verif_____
Verif
EOC
# Required_____
# Verif_____
Outdoor Warning Siren(s)
Outdoor Warning Siren(s)
Cable TV Override
Cable TV Override
Plan for Sirens on Emergency Vehicles
Plan for Sirens on Emergency Vehicles
Local Alert Broadcast System*
Local Alert Broadcast System*
Local Pager System* (For dissemination)
Local Pager System* (For dissemination)
Telephone Tree to Critical Facilities
Telephone Tree to Critical Facilities*
Coordinated Area-Wide Radio Network*
Coordinated Area-Wide Radio Network*
Local Flood Warning System*
Local Flood Warning System*
Other*_____________________________
Other*________________________________
Other*_____________________________
Verif
Other*________________________________
List any additional capabilities on a separate sheet
*Capabilities needing explanation:
Verification Team Notes:
Renewal Comments:
Date:
Initials:
Note: Please do not write in shaded areas.
Page 4
Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service
Application Form
OMB Control # 0648-0419
Expires 06/30/2009
Local Government-Owned Buildings in Which Public Traffic is Common
Office
Location or Address
Tone Alert NOAA
Weather Radio
Verif
Comments
Warning Point
EOC
City Hall
School Superintendent
Verification Team Notes:
Renewal Comments:
Date:
Initials:
Note: Please do not write in shaded areas.
Page 5
Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service
Application Form
OMB Control # 0648-0419
Expires 06/30/2009
Guideline 5:
Community Preparedness
Annual Safety Talks
Date
# Required_____
Topic
# Verif_____
Location
Speaker
1
2
3
4
5
List any additional safety talks on a separate sheet
Verif
Community Tsunami Awareness Program
Designate/establish tsunami shelter/area in safe zone.
Designate tsunami evacuation areas and evacuation routes, and install evacuation route signs.
Provide written, locally specific tsunami hazard response material to public.
Encourage schools to implement a tsunami hazard curriculum, practice evacuations, and provide safety
material to staff and students.
Number of annual tsunami awareness campaigns:___________________________________
Weather Radio Purchase Program
Has your community/county developed a program to subsidize the purchase of Specific Area Message Encoder (SAME)
equipped Weather Radios for its citizens? (Not required) Yes_____ No______
If yes, provide details:
Other Community Preparedness Activities
Date
Activity
Location
Organizer
1
2
3
List any additional activities on a separate sheet
Renewal Comments:
Date:
Initials:
Note: Please do not write in shaded areas.
Page 6
Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service
Guideline 6:
Application Form
OMB Control # 0648-0419
Expires 06/30/2009
Verif
Administrative Tools/Record Keeping
Renewal
Formal Tsunami Hazard and Hazardous Weather Operations Plan
• Procedure for reporting storm/tsunami damage to the local National
Weather Service Office in real-time
• EOC Activation Procedures
• Spotter Activation Criteria
• Local Warning System(s) Activation Criteria
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Warning Point personnel has authority to activate Warning System (written)
Yes
Yes
Spotter Roster and Training Record
Yes
Yes
Last Visit by Emergency Manager to NWS Office
Biennial
Last Visit by NWS Officials to Community
Annual
Last NWS Spotter Training for Spotters and Dispatchers
Biennial
Last NWS Spotter Training Hosted/Co-Hosted (For populations >40,000)
Exercises
Annual
Date:
Date:
Date:
List any additional descriptions, narratives, or documentation on a separate sheet
Verification Team Notes:
Renewal Comments:
Date:
Initials:
Signature of Applying Official
Application Submitted by (print name):
Office:
Title:
Signature:
Date:
NWS Personnel Receiving Application (print name):
Date Received:
Note: Please do not write in shaded areas.
Page 7
Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service
Application Form
OMB Control # 0648-0419
Expires 06/30/2009
Site Verification Team Signatures
Print Name:
Office:
Title:
Signature:
Date:
Print Name:
Office:
Title:
Signature:
Date:
Print Name:
Office:
Title:
Signature:
Date:
Print Name:
Office:
Title:
Signature:
Date:
Signature in Renewal Year
Application Submitted by: (print name):
Office:
Title:
Signature:
Date:
NWS Personnel Receiving Application (print name):
Date Received:
Page 8
| File Type | application/pdf |
| File Title | Microsoft Word - TR-SRApp2-09.doc |
| Author | magnusmj |
| File Modified | 2009-03-16 |
| File Created | 2009-02-18 |