TsunamiReady/StormReady application form

STORMREADY® , TSUNAMIREADY, STORMREADY/TSUNAMIREADY™, AND STORMREADY® SUPPORTER APPLICATION FORMS

TR-SRApp_Jan15

StormReady, TsunamiReady and StormReady/TsunamiReady Application Forms

OMB: 0648-0419

Document [docx]
Download: docx | pdf

Shape1 Department of Commerce

National Oceanic & Atmospheric Administration

National Weather Service

Shape2 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:



Page

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCommunity Information
AuthorAuthourized User
File Modified0000-00-00
File Created2021-01-25

© 2024 OMB.report | Privacy Policy