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
Pagers1 (warning reception)		Pagers2 (warning reception)
Television (Local network or Cable TV)		Television (Local network or Cable TV)
Radio Station (AM/FM) - EAS Reception		Radio Station (AM/FM) - EAS Reception
NAWAS		NAWAS
Internet (subscription for alerts)______________		I Internet (subscription for alerts)____________
Commercial Data Service_________________		Commercial Data Service_________________
Other3_________________________________		Other4________________________________
Other5_________________________________		Other6________________________________
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 (Wind gauge)

Anemometer (Wind gauge)

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_____		Verified	EOC # Required_____ # Verif_____			Verified
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
Telephone Tree to Critical Facilities			Telephone Tree to Critical Facilities
Local Alert Broadcast System*			Local Alert Broadcast System*
Local Pager System* (dissemination)			Local Pager System* (dissemination)
Coordinated Area-Wide Radio Network*			Coordinated Area-Wide Radio Network*
Local Flood Warning System*			Local Flood Warning System*
Other*_____________________________			Other*________________________________
Other*_____________________________			Other*________________________________
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
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
4
5
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 Year
Formal Hazardous Weather Operations Plan Procedure for reporting storm damage to the local National Weather Service Office in real-time EOC Activation Procedures Spotter Activation Criteria Local Warning System(s) Activation Criteria
Warning Point personnel has authority to activate Warning System (written)
Spotter Roster and Training Record
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	Topic(s):		Date:		Date: Date: D
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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