TsunamiReady application from

Department of Commerce National Oceanic & Atmospheric Administration National Weather Service

Application Form

OMB Control # 0648-0419

Expires 08/31/2018

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: Communications
Location of 24-Hour Warning Point			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.

Guideline 2: NWS Information Reception Equipment
Warning Point # Required # Verif	Verif	EOC # Required # Verif			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*
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.

Guideline 3:	Local Warning Dissemination
Warning Point # Required # Verif		Verif	EOC # Required # Verif			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*			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.

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.

Guideline 4:			Community Preparedness
Annual Safety Talks # Required # Verif
Date			Topic		Location		Speaker
1
2
3
4
5
List any additional safety talks on a separate sheet
Community Tsunami Awareness Program									Verif
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.

_{Guideline 5: Administrative Tools/Record Keeping} ^{Verif Renewal}

Tsunami Hazard in Emergency Response Plan

Procedure for reporting tsunami impacts and damage to the local National

Weather Service Office in real-time

EOC Activation Procedures

WP Activation Procedures

_{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}

_{Tsunami evacuation routes documented Yes Yes}

_{Last Visit by Emergency Manager to NWS Office} ^Biennial

Last Visit by NWS Officials to Community

Annual

_{Last Visit by Emergency Manager to NWS Office} ^Annual

_Exercises ^{Topic(s): 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.

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:

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