TsunamiReady/StormReady application form

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 Weather & Water Monitoring Equipment
Warning Point # Required_____ # Verif_____		Verif	EOC # Required_____ # Verif_____			Verif
Anemometer			Anemometer
Rain Gauge			Rain Gauge
River Gauge			River Gauge
Locally owned radar			Locally owned radar
Internet Radar Source ___________________			Internet Radar Source ___________________
Internet Weather Station __________________			Internet Weather Station __________________
TV Radar Source ________________________			TV Radar Source ________________________
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 4:	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 5:

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 6: Administrative Tools/Record Keeping

Verif

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 G 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)

Annual

Exercises

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.

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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