Community Information |
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County/City/Town |
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Population |
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Primary Point of Contact |
Secondary Point of Contact |
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Name |
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Name |
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Office |
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Office |
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Title |
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Title |
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Mailing Address |
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Mailing Address |
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City |
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City |
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State; ZIP |
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State; ZIP |
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Phone |
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Phone |
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Guideline 1: Communications |
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Location of 24-Hour Warning Point |
Location of Emergency Operations Center |
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Verification Team General Notes: |
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Renewal Comments: |
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Date: |
Initials: |
Note: Please do not write in shaded areas. |
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* - Reference Criteria on page 9.
Guideline 2: NWS Information Reception Equipment |
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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 |
□ |
□ Pagers* (warning reception) |
□ |
□ Pagers* (warning reception) |
□ |
□ Television (Local network or Cable TV) |
□ |
□ Television (Local network or Cable TV) |
□ |
□ Radio Station (AM/FM) - EAS Reception |
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□ Radio Station (AM/FM) - EAS Reception |
□ |
□ NAWAS |
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□ NAWAS |
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□ Internet (subscription for alerts)______________ |
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□ Internet (subscription for alerts)_____________ |
□ |
□ Commercial Data Service_________________ |
□ |
□ Commercial Data Service_________________ |
□ |
□ Other*_________________________________ |
□ |
□ Other*_________________________________ |
□ |
□ Other*_________________________________ |
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□ Other*_________________________________ |
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List any additional capabilities on a separate sheet |
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*Capabilities needing explanation: |
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Verification Team Notes: |
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Renewal Comments: |
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Date: |
Initials: |
Note: Please do not write in shaded areas. |
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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 |
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□ Locally owned Radar |
□ |
□ Internet Radar Source _________________ |
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□ Internet Radar Source ____________________ |
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□ Internet Weather Station _______________ |
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□ Internet Weather Station __________________ |
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□ TV Radar Source_____________________ |
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□ TV Radar Source________________________ |
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□ Other* ______________________________ |
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□ Other* _________________________________ |
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□ Other* ______________________________ |
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□ Other* _________________________________ |
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List any additional capabilities on a separate sheet |
*Capabilities needing explanation: |
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Verification Team Notes: |
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Renewal Comments: |
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Date: |
Initials: |
Note: Please do not write in shaded areas. |
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Guideline 4: |
Local Warning Dissemination |
Warning Point # Required____ # Verif_____ |
Verified |
EOC # Required_____ # Verif_____ |
Verified |
□ Outdoor Warning Siren(s) |
□ |
□ Outdoor Warning Siren(s) |
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□ Cable TV Override |
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□ Cable TV Override |
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□ Plan for Sirens on Emergency Vehicles |
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□ Plan for Sirens on Emergency Vehicles |
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□ Telephone Tree to Critical Facilities |
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□ Telephone Tree to Critical Facilities |
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□ Local Alert Broadcast System* |
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□ Local Alert Broadcast System* |
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□ Local Pager System* (dissemination) |
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□ Local Pager System* (dissemination) |
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□ Coordinated Area-Wide Radio Network* |
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□ Coordinated Area-Wide Radio Network* |
□ |
□ Local Flood Warning System* |
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□ Local Flood Warning System* |
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□ Other*_____________________________ |
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□ Other*________________________________ |
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□ Other*_____________________________ |
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□ Other*________________________________ |
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List any additional capabilities on a separate sheet |
*Capabilities needing explanation: |
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Verification Team Notes: |
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Renewal Comments: |
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Date: |
Initials: |
Note: Please do not write in shaded areas. |
Local Government-Owned Buildings in Which Public Traffic is Common |
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Office |
Location or Address |
Tone Alert NOAA Weather Radio |
Verif |
Comments |
Warning Point |
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EOC |
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City Hall |
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School Superintendent |
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Verification Team Notes: |
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Renewal Comments: |
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Note: Please do not write in shaded areas. |
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Guideline 5: |
Community Preparedness |
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Annual Safety Talks # Required_____ # Verif_____ |
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Date |
Topic |
Location |
Speaker |
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1 |
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2 |
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3 |
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4 |
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