TsunamiReady Supporter Application

TsunamiReady Supporter
Application Form
OMB Control 0648-0419
Expires 5/31/2018

Department of Commerce
National Oceanic & Atmospheric Administration
National Weather Service

TsunamiReady® Supporter Application
Contact Information
Applicant Entity Name:

Peak # Occupants:

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:

Email Address:

Email Address:

Location of Communications
Center (if applicable):
Notes

Please do not write in shaded areas.

Public reporting burden for this collection of information is estimated to average one hour 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 Rocky Lopes, National Weather Service, 1325 East West Highway, Room 13-121, Silver Spring, MD, 20910.
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.

TsunamiReady Supporter

Page 1 of 3

TsunamiReady Supporter
Application Form
OMB Control 0648-0419
Expires 5/31/2018

Department of Commerce
National Oceanic & Atmospheric Administration
National Weather Service

TsunamiReady Supporter Criteria*
(Check all that apply)
1. Have Ways to Receive
Tsunami Messages (at
least two, one should
include warnings,
advisories, and watches)

☐
☐
☐
☐
☐
☐

NOAA Weather Radio
TV/cable
Radio
Private providers
Wireless Emergency Alerts (warnings only)
Email/text notifications

Other (list below)

Verified
☐

Hours messages monitored (at
least when entity is occupied):
2. Have Ways to
Communicate Tsunami
Messages (at least two,
should include warnings
and advisories, at least)

☐
☐
☐
☐
☐

Public address
Sirens
Email/text notifications
Phone
Door-to-door

Other (list below)

Verified
☐

Hours messages issued (at
least when entity is occupied):
3. Make Tsunami Hazard
or Evacuation Zone
Map Available

☐ Posted in central location (at least one per
occupied building)
☐ Posted throughout entity
☐ Distributed
☐ Available online (e.g., intranet or website)

Other (list below)

Verified
☐

Date of most current map:
Map provider:
4. Conduct Tsunami
Awareness and
Preparedness
Activities for:
☐ Staff
☐ Residents
☐ Visitors
☐ Others (list):

☐ Annual major outreach/education activity (at
least one, should include staff)
☐ Other outreach/education activities

5. Have Tsunami
Response Plan with
Evacuation
Instructions

☐ Print copy available
☐ Electronic copy available
☐ Print copy posted in common area

Other (list below)

Verified
☐

Drills and exercises
☐ Tsunami evacuation drill
☐ Participate in community tsunami exercise
Other (list below)

Verified
☐

Describe additional activities entity does to support TsunamiReady program goals:

Verified
☐

*For more information about these criteria refer to the “TsunamiReady Supporter Information” available at
http://www.tsunamiready.noaa.gov/supporters.shtml.
TsunamiReady Supporter

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TsunamiReady Supporter
Application Form
OMB Control 0648-0419
Expires 5/31/2018

Department of Commerce
National Oceanic & Atmospheric Administration
National Weather Service

Signature of Applying Official
Name of Applying Entity:
Name of Applying Official:

Title:

Signature:

Date:

NWS Personnel Receiving
Application (print name):

Date
Received:

NWS Approver Signature
NWS Office:
Print Name:

Title:

Signature:

Date:

NWS Signature in Renewal Year
Name of Renewing Official:

Title:

NWS Office:
NWS Personnel Receiving
Renewal Request (print
name):

Date

NWS Approver (print name):

Title:

Signature:

Date:

TsunamiReady Supporter

Received:

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