Form FEMA Form FF-104-F FEMA Form FF-104-F Urban Search and Rescue Response System Task Force Self

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Overview

Cover Sheet
Scoresheet
PD. Training Reqs. (1)
PD. Training Reqs. (2)
PD. Training Reqs. (3)
PD. Training Reqs. (4)

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Sheet 1: Cover Sheet

Department of Homeland Security

OMB 1660-0073 Expires XX XX, 20XX

Federal Emergency Management Agency

NATIONAL URBAN SEARCH AND RESCUE RESPONSE SYSTEM

Task Force Self-Evaluation Scoresheet

PAPERWORK BURDEN DISCLOSURE NOTICE FEMA Form FF-104-FY-21-177 (formerly 089-0-14)

Public reporting burden for this data collection is estimated to average 2 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. This collection of information is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW., Washington, DC 20472-3100, Paperwork Reduction Project (1660-0073) NOTE: Do not send your completed form to this address.

INSTRUCTIONS

*Prior to completing this self-evaluation, consult current guidance from the FEMA US&R Branch*

With the use of this form, three areas of readiness will be evaluated:

Operational Readiness – availability of a complement of rostered, trained, deployable, exercised members and canine search specialist teams.

Logistic Readiness – availability of equipment caches and other logistic resources to support immediate deployment.

Management Readiness – in-place resources, plans, agreements, processes, and procedures to support deployments, and meet requirements of the US&R’s Preparedness Cooperative Agreements and other audit requirements.

OPERATIONAL READINESS

1. Number of Rostered TF Members

max score: 15

10

2. Number of Trained TF Members

max score: 15

3. Number of Deployable TF Members

max score: 30

4. Number of TF Member Participants in annual exercises

max score: 30

5. Number of TF Member Participants in annual training

max score: 10

15

Total Operational Readiness

max score: 100

LOGISTICS READINESS

1. Number of cache equipment items

max score: 50

40

2. Transportation Resources

max score: 15

20

3. Equipment Cache Training and Exercises

max score: 15

20

4. Cache Management inventory system

max score: 10

10

5. Warehouse Resources

max score: 10

10

Total Logistics Readiness

max score: 100

MANAGEMENT READINESS

1. Number of Administrative staffing/resources

max score: 20

2. Cooperative Agreement reporting

max score: 20

3. Cooperative Agreement Plans and Memoranda of Agreement

max score: 20

4. Financial and Accounting Processes and Records

max score: 20

5. Sponsoring Agency Support Functions

max score: 20

Total Management Readiness

max score: 100

This scoresheet has been provided for your task force to make the required point entries and calculate scores. More specific guidance on methodology and scoring criteria will be provided separately.

FEMA Form FF-104-FY-21-177 (formerly 089-0-14) (2022)

Page 1 of 6

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Sheet 2: Scoresheet

U.S. Department of Homeland Security
FEMA National Urban Search & Rescue Response System
Task Force Self-Evaluation Scoresheet
					Task Force:
					Date Completed:
	TASK FORCE OPERATIONAL READINESS
								Members	Points	Score
		1) Number of Rostered Task Force (TF) Members:						Auto-fills from next 3 tabs. 0	0	0
		2) Number of Trained TF Members: (Max 15 pts for 2 & 2a)						Auto-fills from next 3 tabs. 0	0	0
		2a) TF Members Trained in More Than One Specialty:						Enter the number of TF members trained in more than one specialty.	0	0
		3) Number of Deployable TF Members:						Auto-fills from next 3 tabs. A minimum of 3 deployable MTMs and 3 deployable SSs must be entered on the following tabs, or the points and score here will be "0". 0	0	0
		4) Number of TF Members Participating in Annual Training / Exercises:
		4a) Deployment Exercises: (Max 30 pts for 4a & 4b)						Enter the number of TF members that participated in Deployment Exercises.	0	0
		4b) Modular or Mobilization Exercises:						Enter the number of TF members that participated in Modular or Mobilization Exercises.	0	0	0
		5) Number of TF Members Participating in Annual Training:							0	0
									Task Force Operational Readiness Total Score:	0
	TASK FORCE LOGISTICAL READINESS
									Points	Score
		1) Compliment of Approved Equipment Cache Items:								0
		2) Compliment of Transportation Resources:								0
		3) Equipment Cache Training and Exercises:								0
		4) Cache Management Inventory System:								0
		5) Warehouse Facilities:								0
									Task Force Logistical Readiness Total Score:	0
	TASK FORCE MANAGEMENT READINESS
									Points	Score
		1) Number of Administrative Staffing/Resources:								0
		2) Cooperative Agreement Reporting:								0
		3) Cooperative Agreement Plans & Memoranda of Agreement:								0
		4) Financial / Accounting Processes and Records:								0
		5) Sponsoring Agency Support Functions:								0
									Task Force Management Readiness Total Score:	0
									Task Force Self-Evaluation Total Score:	0
	Note for following data entry pages:
A grayed out item is a new training requirement in the Position Descriptions and
is not scored on the Task Force Self-Evaluations or Administrative Readiness Evaluations.
FEMA Form FF-104-FY-21-177 (formerly 089-0-14) (2022)										Page 2 of 6

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Sheet 3: PD. Training Reqs. (1)

U.S. Department of Homeland Security

FEMA National Urban Search & Rescue Response System

Task Force Self-Evaluation Scoresheet - continuation

US&R Position Description Training Requirements

Task Force:

1) Canine Search Specialist (CSS) (4 pos. x 3 deep)

# rostered as CSS (12 max):

1a) Meet all Administrative & General Training requirements:

1b) Have current certification as a FEMA US&R Canine Search Specialist Team:

1c) Complete the FEMA US&R Canine Search Specialist Course:

1d) Complete the FEMA US&R GPS Awareness Level Course:

1e) Complete the required Technical Rescue Skill Sets (TRSSs) as defined in Appendix A of

the FEMA US&R Opereations Manual Annex E - Position Descriptions:

# of CSS trained (12 max):

# of CSS deployable (12 max):

2) Communications Specialist (CS) (2 pos. x 3 deep):

# rostered as CS (6 max):

2a) Meet all Administrative & General Training requirements:

2b) Complete the FEMA US&R GPS Awareness Level Course:

2c) Complete the FEMA US&R Communications Specialist Course:

# of CS trained (6 max):

# of CS deployable (6 max):

3) Hazardous Materials Specialist (HMS) (8 pos. x 3 deep):

# rostered as HMS (24 max):

3a) Meet all Administrative & General Training requirements:

3b) Meet & maintain the requirements as a certified Hazardous Materials Technician per OSHA

Standard 29 CFR 1910.120 "Hazardous Waste Operations and Emergency Response":

3c) Meet & maintain the AHJ competencies in accordance with NFPA Standard 472:

3d) Complete the FEMA US&R WMD Considerations for the Hazardous Materials Specialist:

3e) Complete all required TRSSs as defined in Appendix A of Ops Manual Annex E:

# of HMS trained (24 max):

# of HMS deployable (24 max):

4) Hazardous Materials Manager (HMM) (2 pos. x 3 deep):

# rostered as HMM (6 max):

4a) Meet all Administrative & General Training requirements:

4b) Meet all of the FEMA US&R Hazardous Materials Specialist PD "Required Training":

# of HMM trained (6 max):

# of HMM deployable (6 max):

5) Heavy Equip. Rigging Specialist (HERS) (2 pos. x 3 deep)

# rostered as HERS (6 max):

5a) Meet all Administrative & General Training requirements:

5b) Complete the Heavy Equipment & Rigging Specialist Course:

5c-1) Experienced in heavy construction field, such as heavy equipment operator, crane operator,

iron worker, rigger, or other applicable field:

OR

5c-2) A minimum of three years experience as a Rescue Specialist on a Task Force:

# of HERS trained (6 max):

# of HERS deployable (6 max):

6) Logistic Specialist (LS) (4 pos. x 3 deep):

# rostered as LS (12 max):

6a) Meet all Administrative & General Training requirements:

6b) Complete the FEMA US&R GPS Awareness Level Course:

6c) Complete the FEMA US&R Logistics Specialist Course:

6d) Complete an OSHA Title 49 CFR 1910.178 course (Forklift Training):

6e) Complete a DOT Title 49 CFR 172.704 course (HazMat Handler / Packer / Labeler):

# of LS trained (12 max):

# of LS deployable (12 max):

7) Logistics Team Manager (LTM) (2 pos. x 3 deep):

# rostered as LTM (6 max):

7a) Meet all Administrative & General Training requirements:

7b) Meet all of the FEMA US&R Logistics Specialist PD "Required Training":

7c) Complete & maintain certification as a Certifying Official for Transportation Requirements &

Regulations - Air & Ground (IATA, Title 49 CFR 3, & AFMAN 24-204):

0

# of LTM trained (6 max):

0

# of LTM deployable (6 max):

0

FEMA Form FF-104-FY-21-177 (formerly 089-0-14) (2022)

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0

Page 3 of 6

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Sheet 4: PD. Training Reqs. (2)

U.S. Department of Homeland Security

FEMA National Urban Search & Rescue Response System

Task Force Self-Evaluation Scoresheet - continuation

US&R Position Description Training Requirements

Task Force:

8) Medical Specialist (MS) (4 pos. x 3 deep):

# rostered as MS (12 max):

8a) Meet all Administrative & General Training requirements:

8b-1) Currently certified / licensed as an EMT-Paramedic and meet local jurisdiction requirements,

actively participating in pre-hospital care:

8b-2) Currently certified / licensed as a Physician Asst, Reg. Nurse-Pract., or Reg. Nurse, with an accredited

organization or municipality, meets the NREMT-P Standards or State certification requirements, actively

practices advanced pre-hospital life support, and currently certified in BTLS, ACLS and PALS:

8c) Complete the FEMA US&R Medical Team Training Course:

8d) Complete the FEMA US&R WMD Considerations for the Medical Team Training Course:

8e) Complete all required TRSSs as defined in Appendix A of Ops Manual, Annex E:

# of MS trained (12 max):

# of MS deployable (12 max):

9) Medical Team Manager (MTM) (2 pos. x 3 deep)

# rostered as MTM (6 max):

9a) Meet all Administrative & General Training requirements:

9b-1) Currently licensed physician, emergency medicine residency-trained, and/or Board-certified in emergency

medicine, & practices clinical emergency medicine, w/pre-hospital medical care experience:

OR

9b-2) Currently licensed physician whose medical activities include clinical emergency and

pre-hospital medical care. Currently certified in ACLS, ATLS, and PALS (or equivalent):

9c) Complete the FEMA US&R Medical Team Training Course:

# of MTM trained (6 max):

# of Med Team Managers deployable (min of 3 required, 6 max):

10) Planning Team Manager (PTM) (2 pos. x 3 deep):

# rostered as PTM (6 max):

10a) Meet all Administrative & General Training requirements:

10b) ICS 300 in accordance w/the NSCTD Guidance:

10c) Complete the FEMA US&R Planning Team Training Course:

# of PTM trained (6 max):

# of PTM deployable (6 max):

11) Rescue Specialist (RS) (20 pos. x 3 deep)

# rostered as RS (60 max):

11a) Meet all Administrative & General Training requirements:

11b) Complete the FEMA US&R GPS Awareness Level Course:

11c) Meet requirements - NFPA 1006 Tech Rescue Level 1 & 2 (Chapters 5, 6, 7, 8, 10, & 11):

11d) Complete the FEMA US&R Structural Collapse Technician Course or equivalent:

11e) Current certification in Basic First Aide for First Responders or equivalent:

# of RS trained (60 max):

# of RS deployable (60 max):

12) Rescue Squad Officer (RSO) (4 pos. x 3 deep)

# rostered as RSO) (12 max):

12a) Meet all requirements of the Rescue Specialist:

12b) Shall have experience in /FEMA US&R structural collapse operations to include

participation in field exercise(s) and/or a deployment as a RS:

# of RSO trained (12 max):

# of RSO deployable (12 max):

13) Rescue Team Manager (RTM) (2 pos. x 3 deep)

# rostered as RTM (6 max):

13a) Meet all requirements of the Rescue Squad Officer:

13b) ICS 300 in accordance w/the NSCTD Guidance:

# of RTM trained (6 max):

# of RTM deployable (6 max):

14) Safety Officer (SO) (2 pos. x 3 deep)

# rostered as SO (6 max):

14a) Meet all Administrative & General Training requirements:

14b) Complete the FEMA US&R GPS Awareness Level Course:

14c) ICS 300 in accordance w/the NSCTD Guidance:

14d) Complete the FEMA US&R Structural Collapse Technician Course or equivalent:

14e) Complete the FEMA US&R Safety Officer Course:

14f) Meet requirements - NFPA 1006 Tech Rescue Level 1 & 2 (Chapters 5, 6, 7, 8, 10, & 11):

14g) Current certification in Basic First Aide for First Responders or equivalent:

0

0

0

0

# of SO trained (6 max):

0

# of SO deployable (6 max):

0

FEMA Form FF-104-FY-21-177 (formerly 089-0-14) (2022)

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Page 4 of 6

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Sheet 5: PD. Training Reqs. (3)

U.S. Department of Homeland Security

FEMA National Urban Search & Rescue Response System

Task Force Self-Evaluation Scoresheet - continuation

US&R Position Description Training Requirements

Task Force:

15) Search Team Manager (STM) (2 pos. x 3 deep)

# rostered as STM (6 max):

15a) Meet all Administrative & General Training requirements:

15b) Complete the FEMA US&R Technical Search Specialist Course:

15c) Complete the FEMA US&R Canine Search Specialist Course:

15d) Shall have experience in /FEMA US&R Technical or Canine Search operations to include participation

in field exercise(s) and/or a deployment or equivalent as defined by the Sponsoring Agency

(Does not apply to those members rostered as STMs prior to July 1, 2008)

# of STM trained (6 max):

# of STM deployable (6 max):

16) Structures Specialist (SS) (2 pos. x 3 deep):

# rostered as SS (6 max):

16a) Meet all Administrative & General Training requirements:

16b) Complete the FEMA US&R GPS Awareness Level Course:

16c) Complete the USACE Structures Specialist Training Course (StS 1):

16d) Complete all required TRSSs as defined in Appendix A of the FEMA US&R PD Manual:

16e) Be currently licensed as a Professional Engineer specializing in structures or *equivalent

as sanctioned by the FEMA US&R Structures Sub-Group:

AND

16f) Have a sum of 5 years experience in structure design and analysis to include evaluation of

existing structures, field investigation or construction observation experience:

# of SS trained (6 max):

# of Structures Specialists deployable (min of 3 required, 6 max):

17) Task Force Leader (TFL) (2 pos. x 3 deep)

# rostered as TFL (6 max):

17a) Meet all Administrative & General Training requirements:

17b) Complete ICS 400 in accordance w/the NSCTD Guidance:

17c) Complete the FEMA US&R Task Force Leaders Course:

# of TFL trained (6 max):

# of TFL deployable (6 max):

18) Technical Information Specialist (TIS) (2 pos. x 3 deep):

# rostered as TIS (6 max):

18a) Meet all Administrative & General Training requirements:

18b) Complete the FEMA US&R Planning Team Training Course:

# of TIS trained (6 max):

# of TIS deployable (6 max):

19) Technical Search Specialist (TSS) (2 pos. x 3 deep)

# rostered as TSS (6 max):

19a) Meet all Administrative & General Training requirements:

19b) Complete the FEMA US&R Technical Search Specialist Course:

19c) Complete all required TRSSs as defined in Appendix A of the Ops Manual, Annex E:

# of TSS trained (6 max):

# of TSS deployable (6 max):

Total Task Force rostered members listed:

0

0

Total Task Force trained members listed:

0

0

Total Task Force deployable members listed:

0

0

FEMA Form FF-104-FY-21-177 (formerly 089-0-14)

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0

Page 5 of 6

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Sheet 6: PD. Training Reqs. (4)

U.S. Department of Homeland Security

FEMA National Urban Search & Rescue Response System

Task Force Self-Evaluation Scoresheet - continuation

US&R Position Description Training Requirements

Task Force:

Water Rescue Specialist (WRS) (14 pos x 2 deep)

# rostered as WRS:

a) Meet all Administrative & General Training requirements:

b) Complete the GPS Awareness Course:

c) Meet requirements of current NFPA 1006, Surface Water Rescue (Level 1 & 2)

d) Meet requirements of current NFPA 1006, Swiftwater Rescue (Level 1 & 2)

e) Meet requirements of current NFPA 1006, Rope Rescue (Level 1 & 2)

f) Complete a minimum swim requirement per the AHJ (Sponsoring/Participating Agency)

# of WRS trained:

# of WRS deployable:

Jon / Flat Boat Operator (BO) - 12 Operators

# rostered as JBO:

a) Meet all Administrative & General Training requirements:

b) Complete the GPS Awareness Course:

c) Meet requirements of a US&R Water Rescue Specialist

d) Safe boating certificate recognized by the National Safe Boating Council or equivalent

e) Complete boat operator requirements as outlined in the US&R Boat Operator Position Task Book

Note: PTB shall note: Jon Boat Operator

# of JBO trained:

# of JBO deployable:

Swift Water Boat Operator (SWBO) - 6 Operators

# rostered as SW/IRB BO:

a) Meet all Administrative & General Training requirements:

b) Complete the GPS Awareness Course:

c) Meet requirements of a US&R Water Rescue Specialist

d) Safe boating certificate recognized by the National Safe Boating Council or equivalent

e) Complete boat operator requirements as outlined in the US&R Boat Operator Position Task Book

Note: PTB shall note: SW or IRB Boat Operator

# of SW/IRB BO trained:

# of SW/IRB BO deployable:

FEMA Form FF-104-FY-21-177 (formerly 089-0-14)

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