Incident Name:
Priority
When do you need this request fulfilled? o 0-4 hours o 4-8 hours o 8-12 hours o 12-36 hours o Longer than 36 hours
Justification Does the county or local jurisdiction have the ability to contract for these resources? o Yes o No
Have you exhausted all mutual aid options in the surrounding counties? o Yes o No
Additional justification for the requested resource(s): Justification Examples: Local jurisdiction does not have this resource... All existing resources have been contracted out... Surrounding counties are also impacted... No mutual aid is available...
Requesting Jurisdiction Requester Agency: Operational Area:
Requested Resources Resource Name: Quantity Requested (ea): Detailed Resource Description: (Vital characteristics, brand, specs, experience, size, etc.) Is an operator needed for this resource?
Request Summary (Why is this resource needed and what will it do):
Actions taken on this request so far (what have you done to obtain the resource on your own)?
Requester Information Requester First & Last Name: Requester Email: Requester Phone: Requester Title:
Delivery Information Recipient First & Last Name: Delivery Recipient Email: Delivery Recipient Phone: Delivery Recipient Title: Delivery Recipient Entity Name: Delivery Location: Delivery Notes:
FOR PARISH GOHSEP AND STATE EOC AUXCOMM USE RESOURCE REQUEST FORM OPERATIONS SECTION • PHONE: (225) 925-7500 • FAX: (225) 925-7501
{var rESOURCEtYPE}
PHONE:
{var ReqPhone}
ALT. PHONE: {var ReqPhone2}