StormReady Application

Department of Commerce National Oceanic & Atmospheric Administration National Weather Service

Application Form OMB Control # 0648-0419 Expires 09/30/2021

Community Information
Date of Application
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 ______________________________	☐	☐ 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* ______________________________		☐	☐			☐
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)			☐	☐ Biennial
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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