StormReady application form

STORMREADY® , TSUNAMIREADY, TSUNAMIREADy SUPPORTER, AND STORMREADY® SUPPORTER APPLICATION FORMS

SRApp_Jan15

StormReady and TsunamiReady Applications

OMB: 0648-0419

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Shape180 Department of Commerce

National Oceanic & Atmospheric Administration

National Weather Service

Shape181 Application Form

OMB Control # 0648-0419

Expires 08/31/2018

Shape182

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

Shape1 NOAA Weather Radio (required if in range)

Shape2

Shape3 NOAA Weather Radio (required if in range)

Shape4

Shape5 NOAA Weather Wire (subscription)

Shape6

Shape7 NOAA Weather Wire (subscription)

Shape8

Shape9 EMWIN

Shape10

Shape11 EMWIN

Shape12

Shape13 Law Enforcement Teletype (LETS)

Shape14

Shape15 Law Enforcement Teletype (LETS)

Shape16

Shape17 Amateur Radio

Shape18

Shape19 Amateur Radio

Shape20

Shape21 Pagers1 (warning reception)

Shape22

Shape23 Pagers2 (warning reception)

Shape24

Shape25 Television (Local network or Cable TV)

Shape26

Shape27 Television (Local network or Cable TV)

Shape28

Shape29 Radio Station (AM/FM) - EAS Reception

Shape30

Shape31 Radio Station (AM/FM) - EAS Reception

Shape32

Shape33 NAWAS

Shape34

Shape35 NAWAS

Shape36

Shape37 Internet (subscription for alerts)______________

Shape38

Shape39 I Internet (subscription for alerts)____________

Shape40

Shape41 Commercial Data Service_________________

Shape42

Shape43 Commercial Data Service_________________

Shape44

Shape45 Other3_________________________________

Shape46

Shape47 Other4________________________________

Shape48

Shape49 Other5_________________________________

Shape50

Shape51 Other6________________________________

Shape52

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

Shape53 Anemometer (Wind gauge)

Shape54



























Shape55 Anemometer (Wind gauge)

Shape56

Shape57 Rain Gauge

Shape58

Shape59 Rain Gauge

Shape60

Shape61 River Gauge

Shape62

Shape63 River Gauge

Shape64

Shape65 Locally owned Radar

Shape66

Shape67 Locally owned Radar

Shape68

Shape69 Internet Radar Source _________________

Shape70

Shape71 Internet Radar Source ____________________

Shape72

Shape73 Internet Weather Station _______________

Shape74

Shape75 Internet Weather Station __________________

Shape76

Shape77 TV Radar Source_____________________

Shape78

Shape79 TV Radar Source________________________

Shape80

Shape81 Other* ______________________________

Shape82

Shape83 Other* _________________________________

Shape84

Shape85 Other* ______________________________

Shape86

Shape87 Other* _________________________________

Shape88

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

Shape89 Outdoor Warning Siren(s)

Shape90

Shape91 Outdoor Warning Siren(s)

Shape92

Shape93 Cable TV Override

Shape94

Shape95 Cable TV Override

Shape96

Shape97 Plan for Sirens on Emergency Vehicles

Shape98

Shape99 Plan for Sirens on Emergency Vehicles

Shape100

Shape101 Telephone Tree to Critical Facilities

Shape102

Shape103 Telephone Tree to Critical Facilities

Shape104

Shape105 Local Alert Broadcast System*

Shape106

Shape107 Local Alert Broadcast System*

Shape108

Shape109 Local Pager System* (dissemination)

Shape110

Shape111 Local Pager System* (dissemination)

Shape112

Shape113 Coordinated Area-Wide Radio Network*

Shape114

Shape115 Coordinated Area-Wide Radio Network*

Shape116

Shape117 Local Flood Warning System*

Shape118

Shape119 Local Flood Warning System*

Shape120

Shape121 Other*_____________________________

Shape122

Shape123 Other*________________________________

Shape124

Shape125 Other*_____________________________

Shape126

Shape127 Other*________________________________

Shape128













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


Shape129

Shape130


EOC


Shape131

Shape132


City Hall


Shape133

Shape134


School Superintendent


Shape135

Shape136




Shape137

Shape138




Shape139

Shape140




Shape141

Shape142




Shape143

Shape144




Shape145

Shape146




Shape147

Shape148




Shape149

Shape150




Shape151

Shape152




Shape153

Shape154




Shape155

Shape156




Shape157

Shape158


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



Shape159


Shape161 Shape163 Shape162 Shape160

Shape165 Shape164 Shape166 Shape167

Warning Point personnel has authority to activate Warning System (written)

Shape168

Shape169

Shape170

Spotter Roster and Training Record

Shape171

Shape172

Shape174 Shape173

Last Visit by Emergency Manager to NWS Office


Shape175 Biennial


Last Visit by NWS Officials to Community


Shape176 Annual


Last NWS Spotter Training for Spotters and Dispatchers


Shape177 Biennial


Last NWS Spotter Training Hosted/Co-Hosted (For populations >40,000)


Shape178 Annual


Exercises

Topic(s):

Date:

Shape179

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:


Page

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCommunity Information
AuthorAuthourized User
File Modified0000-00-00
File Created2021-01-21

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