Resource Request Questions


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:

Back to links

FOR PARISH GOHSEP AND STATE EOC AUXCOMM USE
RESOURCE REQUEST FORM
              OPERATIONS SECTION • PHONE: (225) 925-7500 • FAX: (225) 925-7501   

 

 GENERAL INFORMATION    RESOURCE DESCRIPTION & DELIVERY INSTRUCTIONS
INCIDENT #:
REQUESTER NAME:

PARISH:

DATE/TIME NEEDED:

DURATION NEEDED:

TRACKING # (DTG/PARISH):

IS DELIVERY REQUIRED: YES      NO
RESOURCE TYPE REQUESTER POC DELIVERY INFORMATION
Air Support
Ambulance
Bottled Water
Bulk Water
Communications
Cots
Debris
DSNAP
Evacuation
Fire Protection
Fuel
Fuel Tanks
Generator
Hazmat
Ice
Intel (Imagery)
Intel (Info)
Legal Support
Levee Support
Liasion
Mass Fatality
Mass Feeding
Medical Support
Mosquito Abate.
MRE (Meals)
PDA/IA
PDA/PA
Pets/Livestock
POD
Public Info
Roadway Inspect.
Sandbags
Search/Rescue
Security
Shelter Support
Tarps
Transportation
Utilities Restore
Waste Water Plnt.
Info Request
FIRST NAME:
LAST NAME:
AGENCY:
PHONE:
ALT. PHONE:
E-MAIL:
POC NAME:
E-MAIL:
PHONE:
ALT. PHONE:
NAME OF SITE:
ADDRESS:
Other
PARISH AUTHORIZATION
SIGNATURE:
POSITION/TITLE:
                                      GOHSEP Resource Request  v 0.1