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Home My Public Portal AboutAgreement_Disaster Management Area D_Area D Regional CERT_Mutual Aid Agreement_2021-03-02DISASTER MANAGEMENT AREA D OF THE LOS ANGELES COUNTY OPERATIONAL AREA AREA D REGIONAL CERT MUTUAL AID AGREEMENT This agreement (herein "Agreement") is made and entered into by and between DISASTER MANAGEMENT AREA D OF THE LOS ANGELES COUNTY OPERATIONAL AREA ("Area D") and the various political subdivisions, municipal corporations and partner agencies ("Agency" or "Agencies"), sometimes referred to individually as "Party" and collectively as "Parties". WHEREAS, natural or man-made disasters such as earthquakes, fires, floods, civil unrest, acts of terrorism or other physical manifestations may affect the peace, health, safety and general welfare of large numbers of persons and extensive area; and WHEREAS, pre -planned events can have a significant impact on a single agency's resources; and WHEREAS, the safety of the citizens within Area D is of the utmost importance at all levels of government; and WHEREAS, to enable Area D to accomplish the objectives of the Standardized Emergency Management System ("SEMS") and the National Incident Management System ("NIMS") by promoting greater efficiencies in disaster management, planning, training, and preparedness, it is essential to coordinate the efforts with the various Agencies; and WHEREAS, such coordination can be accomplished by cooperative management, planning, training, and preparedness action through responsible agencies prior to the time a disaster response is required; and WHEREAS, the Parties to this Agreement are located within Area D and, therefore, have mutual interests and objectives to accomplish with reference to disaster management, planning, training, and preparedness within Area D; and WHEREAS, the Parties to this Agreement believe the arrangements and provisions provided by this Agreement will best serve the public peace, health, safety, and general welfare of said respected Parties. NOW THEREFORE, the Parties to this Agreement mutually agree as follows: 1. Purpose. To provide member cities, partner agencies and first responders a quality resource for pre -planned event and disaster response assistance, when a member city or partner agency does not have sufficient resources and requires additional trained volunteers. This Agreement will implement the Area D Area D Regional CERT Mutual Aid Agreement Regional Community Emergency Response Team ("CERT") Mutual Aid Plan which is attached here to as Exhibit A. 2. Objectives. The objective of the Area D Regional CERT Mutual Aid Plan is to maintain qualified and trained individuals who can augment local public safety and emergency services and emergency management officials by executing the following: a. Assist with sheltering and mass care. b. Assist in victim triage and search and rescue. c. Assist with traffic and crowd management. d. Assist with Commodity Points of Distribution (CPOD) and Medical Points of Distribution (MPOD). e. Assist with staffing other support functions. 3. Liability. a. Each Party agrees to protect, save harmless, indemnify, and defend the other, its governing body, officers, agents, employees, and volunteers from any and all loss, damage or liability (including injury and death), including without limitation, all reasonable legal fees, expert witness or consultant fees and expenses related to the response to, settlement of, or defense of any claims or liability, which may be suffered or incurred by a Party hereto, its governing body, officers, agents, employees and volunteers, caused by, arising out of, or in any way connected with the respective responsibilities and duties hereby undertaken, except that each Party shall bear the proportionate cost of any damage attributable to the fault of that Party, its governing body, officers, agents, contractors, employees, and volunteers. b. By entering into this Agreement, none of the Parties have waived any governmental immunity or limitation of damages which may be extended to them by operation of law. 4. Workers' Compensation. a. Non Disaster -Related Activities. Each Party must provide workers' compensation coverage as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. b. Disaster Service Worker Volunteer — Disaster -Related Activities. Disaster Service Worker Volunteers are eligible for workers' compensation benefits while performing authorized disaster -related duties, including pre - approved training activities as defined in Title 19. Public Safety, Division 2. Revised: 02/03/2021 Page 2 of 4 Area D Regional CERT Mutual Aid Agreement California Emergency Management Agency, Chapter 2. Emergencies and Major Disasters, Subchapter 3. Disaster Service Worker Volunteer Program. c. Volunteers must immediately report an injury suffered while deployed to the assigned supervisor and home agency. 5. Personnel. Each of the Parties shall pay all wages, salaries, and other amounts due to their own personnel in connection with any and all services under this Agreement and required by law. Each Party shall be responsible for all reports and obligations respecting their own personnel, including, but not limited to, applicable social security taxes, income tax withholding, unemployment insurance, and workers' compensation insurance. Employees or agents of one Party shall not be deemed employees of the others for any purpose. 6. Term of Agreement. This Agreement shall become effective as to each Party when approved or executed by the Party, and shall remain operative and effective as between each and every Party that has heretofore or hereafter approved or executed this Agreement, until participation in the Agreement is terminated by the Party. The termination by one or more of the Parties of its participation in this Agreement shall not affect the operation of this Agreement as between the other Parties thereto. 7. Approval or Execution of Agreement. Parties having a legislative or governing body shall by resolution approve and agree to abide by this Agreement, which may be designated as "AREA D REGIONAL CERT MUTUAL AID AGREEMENT." Upon adoption of such resolution, a certified copy thereof shall forthwith be filed with Area D. 8. Termination of Agreement. Parties having a legislative body or governing board shall by resolution give notice of termination of participation in this Agreement and file a certified copy of such resolution with Area D, and this Agreement is terminated as to such Party 30 days after filing such resolution. 9. Governing Law and Venue. This Agreement shall be governed by the laws of the State of California. Venue shall be in Los Angeles County. 10. Successors and Assigns. This Agreement shall be binding on the successors and assigns of the Parties. 11. Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original. Copies of signatures transmitted by facsimile from counsel of the signatory shall be deemed an original counterpart hereunder at all times until receipt of the original signature. Revised: 02/03/2021 Page 3 of 4 Area D Regional CERT Mutual Aid Agreement IN WITNESS WHEREOF this Agreement has been executed and approved and is effective and operative as to each of the Parties as herein provided. DISASTER MANAGEMENT AREA D ATTEST: By Diana Manza no -,,arc a Area D DMAC Date Nlav0 1 f1, //A-7/1 CITY OF E CITY By ook, City Manager Date S ^ 21 - 2-- APPROVED AS TO FORM By p 6lt/D By •— Peggy Kuo, City Clerk Greg hy, City Atto Revised: 02/03/2021 Page 4 of 4 EXHIBIT "A" Area D Regional CERT Mutual Aid Plan FEBRUARY 2021 Area D Regional CERT Mutual Aid Plan Page 2 of 18 This document was prepared by: Bryan Ariizumi City of Temple City Public Safety Supervisor CERT Program Manager Christopher Eddy City of Temple City CERT Team Coordinator For the Use by: Area D Office of Disaster Management and Civil Defense and Area D Cities & Partner Agencies Revision Date: February 3, 2021 Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 3 of 18 Table of Contents PURPOSE 5 MISSION 5 STATEMENT 5 OBJECTIVES 5 AREA D REGIONAL CERT MUTUAL AID PLAN PARTICIPATION Member Cities and Agencies 6 Program Requirements 6 Training Requirements 7 Workers' Compensation 7 CERT VOLUNTEER UNIFORM, IDENTIFICATION BADGE AND EQUIPMENT Uniform 8 Photo Identification (ID) Badge 8 Personal Protective Equipment (PPE) 8 Equipment 8 ACTIVATION Request for Assistance 9 Deployment 10 Demobilization 10 CODE OF CONDUCT 10 ATTACHMENTS 1. Area D Regional CERT Background Check Requirements 13 2. Area D Regional CERT Mutual Aid Request for Assistance Form 15 3. Area D Regional CERT Check -In / Sign -In Sheet 17 Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 4 of 18 THIS PAGE INTENTIONALLY LEFT BLANK Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 5 of 18 AREA D REGIONAL CERT MUTUAL AID PLAN I. PURPOSE To provide member cities, partner agencies and first responders a quality resource for pre - planned event and disaster response assistance, when a member city or partner agency does not have sufficient resources and requires additional trained volunteers. II. MISSION The mission of the Area D Regional Community Emergency Response Team (CERT) Mutual Aid Plan is to harness the power of every individual through education, training, and volunteer service to make communities safer, stronger and better prepared to respond to public health and safety issues and disasters of all kinds. III. STATEMENT The Area D Regional CERT Mutual Aid Plan is part of the local and national Citizen Corps effort to incorporate and utilize volunteers in the community. Citizen Corp is endorsed by the President, the Department of Homeland Security, county operational areas and local jurisdictions, CERT volunteers are trained in basic response techniques and mutual aid training to assist member cities during pre -planned events, disasters and emergency situations. The Area D Regional CERT Mutual Aid Plan: A. Outlines operations for the Area D Regional CERT Mutual Aid Plan; B. Establishes CERT training and equipment requirements; C. Specifies procedures for CERT volunteer activation; and D. Defines CERT volunteer Code of Conduct. IV. OBJECTIVES The objective of the Area D Regional CERT Mutual Aid Plan is to maintain qualified and trained individuals who can augment local public safety and emergency services and emergency management officials by executing the following: A. Assist with sheltering and mass care. B. Assist in victim triage and search and rescue. C. Assist with traffic and crowd management. Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 6 of 18 D. Assist with Commodity Points of Distribution (CPOD) and Medical Points of Distribution (MPOD). E. Assist with staffing other support functions. V. AREA D REGIONAL CERT MUTUAL AID PLAN PARTICIPATION A. Member Cities and Agencies • City of Arcadia • City of Azusa • City of Baldwin Park • City of Bradbury • City of Industry • City of Claremont • City of Covina • City of Diamond Bar • City of Duarte • City of El Monte • City of Glendora • City of Irwindale • City of La Puente • City of La Verne • City of Monrovia • City of Pomona • City of Rosemead • City of San Dimas • City of Sierra Madre • City of South El Monte • City of Temple City • City of Walnut • City of West Covina • Area D Partner Agencies B. Program Requirements Each Agency CERT program (Program) must meet the following requirements to provide CERT volunteers under the Area D Regional CERT Mutual Aid Plan: 1. Program must be sponsored by a local government organization or a State approved Campus CERT program. Program must be affiliated with an Area D city or partner agency ("Agency' or "Agencies"); 2. Program must be registered in the FEMA Citizen Responder Programs Registration; 3. Program must complete a California DOJ and FBI background check (live scan) on all CERT volunteers who will be responding under the Area D Regional CERT Mutual Aid Plan. Any CERT volunteer unwilling to submit to Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 7 of 18 a background check, or if they were convicted of any crime listed in the Area D Regional CERT Background Check Requirements (Attachment 1) is disqualified from participating in Area D Regional CERT Mutual Aid; 4. Program must require all responding CERT volunteers to be sworn in as a Disaster Service Worker Volunteer (DSWV) with their home agency. Programs unable to utilize the DSWV Program must provide workers' compensation coverage to cover responding CERT volunteers for all (i.e., non disaster -related and disaster -related) activities; and C. Training Requirements CERT volunteers responding under the Area D Regional CERT Mutual Aid Plan must complete the following training requirements: 1. CERT Basic Training; 2. Standardized Emergency Management System (SEMS) Introduction Course (G606); 3. ICS -100; 4. IS -700; 5. American Red Cross (ARC) Shelter Fundamentals (only for shelter operation requests); and 6. CERT Traffic and Crowd Management (only for traffic and crowd management requests) Agencies requesting assistance under the Area D Regional CERT Mutual Aid Plan may require additional training and must be identified at the time of the request. It is the responsibility of the Providing Agency to verify and certify that all CERT volunteers responding under the Area D Regional CERT Mutual Aid Plan meet the minimum training requirements. D. Workers' Compensation Work -related injuries to CERT volunteers will be covered by the Providing Agency under their workers' compensation coverage. CERT volunteers must immediately report any injury suffered while deployed, to their assigned supervisor and home agency. Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 8 of 18 VI. CERT VOLUNTEER UNIFORM, IDENTIFICATION BADGE AND EQUIPMENT CERT volunteers responding to an Area D Regional CERT Mutual Aid Request must meet the uniform, identification (ID) badge and equipment standards listed below. A. Uniform CERT volunteers whose home agency issues or requires uniforms, shall wear their CERT uniform and adhere to their agency's uniform policy. Otherwise, CERT volunteers must wear: • Long khaki pants • A plain, solid green shirt (generic CERT shirt is acceptable); • A CERT vest; and • Sturdy shoes or boots (no sandals or open -toed shoes). Depending on weather conditions, CERT volunteers may want to consider additional items such as a jacket, cap/hat, beanie, or gloves. All items must be plain, solid green or black or approved CERT apparel. B. Photo Identification (ID) Badge All CERT volunteers are issued a photo ID badge by their home agency for identification and accountability purposes. When responding to an Area D Regional CERT Mutual Aid request, CERT volunteers must visibly display their CERT ID badge and have, in their possession, a state issued driver's license or identification card. ID badges are to be worn face forward, on or over the outermost garment, above the waist and below the shoulders. ID badges are not to be worn on the waistband or belt. During an activation, lost or stolen ID badges must be immediately reported to the CERT volunteer's program manager or coordinator. Lost or stolen ID badges must be replaced by the CERT volunteer's home agency before participating in another Area D Regional CERT Mutual Aid request. CERT volunteers will not be allowed to participate in any Area D Regional CERT Mutual Aid requests without proper identification. C. Personal Protective Equipment (PPE) When activated to respond to an Area D Regional CERT Mutual Aid request, CERT volunteers must bring their personal protective equipment (i.e., helmet, gloves, goggles, and mask). Additional equipment such as a High Visibility Class 2 Traffic Safety Vest (compliant with ANSI/ISEA 207 Class 2, Level 2 public safety standard), preferably with a CERT logo, will be required for all traffic control events. D. Equipment CERT volunteers must bring basic personal equipment needed to complete the job or function that they will be requested to perform. Basic equipment includes a CERT backpack, flashlight (head lamp and/or hand-held), a whistle and knee pads (optional). Time of day, weather conditions and other factors should be taken into Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 9 of 18 consideration and CERT volunteers may want to include additional items such as rain gear, sunscreen, water bottle/hydration pack, first aid kit, nourishment to be self- sustaining, etc. Rescue or safety equipment owned by a CERT volunteer may not be used unless it is inspected and approved by an authorized representative of the Requesting Agency. Equipment brought with the volunteer must meet or exceed the safety standards of the equipment being provided. Some equipment or items may be provided by the Requesting Agency and will be identified at the time of request. Area D, the Requesting Agency or Providing Agency assumes no liability for items lost, stolen or destroyed. VII. ACTIVATION A. Request for Assistance 1. Agencies with or without CERT programs may request CERT mutual aid. 2. CERT volunteers can be requested for small, single -jurisdictional emergencies or for large-scale disasters involving multiple jurisdictions. CERT volunteers may also be requested to participate in approved local pre - planned events and activities and Emergency Management or CERT training events and exercises. 3. Area D is responsible for coordinating CERT mutual aid within its area. Requests for mutual aid from Area D cities and partner agencies are made to the Area D Disaster Management Area Coordinator (DMAC) by completing the Area D Regional CERT Mutual Aid Request for Assistance Form (Attachment 2). The Area D Regional CERT Mutual Request for Assistance Form must be submitted to the Area D DMAC as soon as possible. If known, the Requesting Agency may provide information regarding specific assignments or tasks to be completed by responding CERT volunteers. 4. For pre -planned events, a completed Area D Regional CERT Mutual Request for Assistance Form must be submitted to the Area D DMAC 30 days in advance of your event. 5. Area D will contact non -affected agencies for CERT volunteers to respond on behalf of the Requesting Agency. 6. Non -affected Agency CERT program managers, coordinators, or designees, will contact their CERT volunteers to check availability and provide assignment details and instructions. Once a mutual aid request is received, Providing Agencies will implement their internal CERT team activation procedures. 7. Requesting Agencies will identify a Point of Contact (POC) and check -in location for CERT volunteers to respond to. Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 10 of 18 8. The Requesting Agency will create a sign-up webpage using www.sicinupgenius.com. Once the sign-up webpage is created, the Requesting Agency will email the link to the Area D DMAC. The Area D DMAC will forward the link to the non -affected Agency CERT program managers or coordinators for dissemination to their CERT team. 9. CERT volunteers must be supervised, directly or indirectly, by a city staff member from the Requesting Agency. B. Deployment 1. Check -In. CERT volunteers arriving at an incident or event will be required to check -in at the location identified by the Requesting Agency. Check -in procedures consist of signing in using the Area D Regional CERT Mutual Aid Check-In/Sign-In Sheet (Attachment 3) and receiving basic information about the incident/event, briefing and/or assignment. 2. Briefing. Briefing, if required, will be provided by a representative, or designee, of the Requesting Agency. Additional details about the incident/event and detailed instructions about assignments may be provided during the briefing. 3. Equipment. Equipment being provided by the Requesting Agency may be issued at the check -in location, during briefing or at the staging area. 4. Injury to CERT Volunteers. There is, as with all activities relating to disaster, emergencies and training, the risk of injury. If injured, the CERT volunteer should immediately notify their assigned supervisor from the Requesting Agency and their home agency. C. Demobilization 1. Hot Wash. CERT volunteers may be requested to participate in a "hot wash" at the conclusion of their shift/assignment or at the conclusion of the incident/emergency/disaster/event/training/exercise. 2. Check -Out. All forms and/or equipment, unless otherwise specified, will be collected at check-out. Final paperwork, including signing out, to clear the CERT volunteer from the incident/emergency/disaster/event/training/exercise will be completed at check-out. VIII. CODE OF CONDUCT All CERT volunteers responding under the Area D Regional CERT Mutual Aid Plan will be expected to comply with the following code of conduct. A. CERT VOLUNTEERS SHALL NOT SELF -ACTIVATE OR SELF -DEPLOY TO AN INCIDENT OR EVENT; Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 11 of 18 B. CERT volunteers are not city employees, law enforcement officers or firefighters. They are trained to function as an extension of a city's emergency response team; C. CERT volunteers shall follow direction of the supervising authority of the Requesting Agency; D. CERT volunteers shall operate within the scope of their training; E. Actions shall be confined to physical and resource limitations of the CERT volunteer. Such limitations may be determined by, but not limited to, available equipment, physical abilities, knowledge, authority, and hazards; F. CERT volunteers shall conduct themselves with professionalism, dignity and pride, and act appropriately and responsibly at all times; G. CERT volunteers shall treat the public, fellow team members, visitors, other volunteer program participants, guests, and property with courtesy and respect; H. CERT volunteers must be sensitive to the diversity of CERT team members and those we assist; I. CERT volunteers shall respect the privacy of persons served under the Area D Regional CERT Mutual Aid Plan and hold, in confidence, all sensitive, private, and personal information; J. CERT volunteers shall not be intoxicated or impaired while undertaking activities as a CERT volunteer, nor shall they report for duty while under the influence of alcohol or drugs; K. CERT volunteers shall not carry or possess any weapons; L. CERT volunteers shall not accept, or seek on behalf of any other person, any money or gifts offered as a result of your affiliation with the Area D Regional CERT Mutual Aid Plan; M. CERT volunteers shall avoid inappropriate conduct that would jeopardize the program's effectiveness. Such behavior includes, but not limited to: 1. Offensive or profane language or gestures. 2. Inappropriate comments or jokes. 3. Public criticism of a CERT team member, its leaders, or the CERT program. 4. Jeopardizing another team member's safety. N. No CERT volunteer shall discriminate against or harass a citizen or team member on the basis of race, religious creed, color, national origin, ancestry, sex, age, physical or mental disability, medical condition, sexual orientation, marital status, gender identity, gender expression, genetic characteristics or information, and/or any other category protected by federal and/or state law. Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 12 of 18 0. If a situation arises where a CERT volunteer feels uncomfortable, offended or confronted, the CERT volunteer should immediately report the incident/situation to the Requesting Agency's CERT Program Manager or Coordinator. If the Requesting Agency's CERT Program Manager or Coordinator is not available, the CERT Volunteer should notify another agency's CERT Program Manager or Coordinator that is on site. The Requesting Agency's CERT Program Manager or Coordinator should notify the Providing Agency's CERT Program Manager or Coordinator and the Area D DMAC as soon as possible. CERT volunteers failing to abide by the Code of Conduct may be prohibited from participating in all Area D Regional CERT Mutual Aid requests or activities, as determined by the Requesting Agency, Providing Agency and/or Area D. Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 13 of 18 ATTACHMENT 1 AREA D REGIONAL CERT BACKGROUND CHECK REQUIREMENTS All CERT volunteers responding under the Area D Regional CERT Mutual Aid Plan are required to have California DOJ and FBI background checks. Disqualification: A person is disqualified from participating in the Area D Regional CERT Mutual Aid Plan if they are unwilling to submit to a background check, or if they were convicted of any of the following: 1. All sex offenses, regardless of the amount of time since the offense (e.g. child molestation, rape, sexual assault, sexual battery, prostitution, solicitation, indecent exposure, etc.) 2. All offenses involving abuse, neglect, or exploitation of a child, elder, or dependent adult regardless of the amount of time since the offense 3. All felony violence, regardless of the amount of time since the offense (e.g., murder, manslaughter, aggravated assault, kidnapping, robbery, aggravated burglary) 4. All felony offenses other than violence or sex within the past 10 years (e.g., drug offenses, theft, embezzlement, fraud) 5. All misdemeanor violence offenses within the past 7 years (e.g., simple assault, battery, domestic violence, etc.) 6. All misdemeanor drug and alcohol offenses within the past 5 years or multiple offenses within the past 10 years (e.g., driving under the influence, simple drug possession, drunk and disorderly, public intoxication, possession of drug paraphernalia, etc.) 7. Any other misdemeanor within the past 5 years that would be considered a potential danger to children, elders, or dependent adults or is directly related to the functions of that volunteer (e.g., contributing to the delinquency of a minor, providing alcohol to a minor, theft, etc.) Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 14 of 18 THIS PAGE INTENTIONALLY LEFT BLANK Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 15 of 18 ATTACHMENT 2 Area D Regional CERT Mutual Aid Request for Assistance Form AREA D REGIONAL CERT MUTUAL AID REQUEST FOR ASSISTANCE EMAIL THE COMPLETED FORM TO AREA D DMAC AT)NFO@AREADONLINE.COM NAME OF EVENT / INCIDENT DATE OF EVENT / INCIDENT TIME OF EVENT / INCIDENT DAY OF WEEK (CIRCLE ONE) S M T W TH F S DESCRIPTION OF EVENT / INCIDENT ,R Y'pieBNd"0 NAME OF REQUESTING AGENCY / JJR ISDICT ION POINT OF CONTACT (POC) FIRST AND LAST NAME POC EMAIL ADDRESS POC WORM ADDRESS SUITE NO. ZIP CODE POC WORK PHONE NO. POC CELL PHONE NO. NUMBER OF CERT VOLUNTEERS REQUESTED TYPE OF ACTIVITY TO BE CONDUCTED BY CERT VOLUNI HERS )EG.. D BOOTH V ACUA T ION SHELTER. El C.) SPECIAL TRAINING OR CERTIFICATIONREQUIRED? (IE., TRAFFIC CONTROL. FIRI SHELTER OPERATIONS. ETC.) AtT REPORTING DATE(S) rAOL.,.£I,D REPORTING. TIME(S) ADDRESS OF CHECK -IN LOCATION OR STAGING AREA PARKING dNSTRUCT IONS FOR RESPONDING CERT VOLUNTEERS TRANSPORATION INFORMATION (WILL CERT VOLUNTEERS BE SHUTTLED TO THEIR ASSIGNED POSTS OR WLL THEY HAVE TO DRIVE THEIR PERSONAL VEHKLES9) IDENTIFY IF SPECIAL EQUIPMENT IS NEEDED (EG_ CLASS 2TRAFFIC SAFETY VEST) lardairri FOR AREA D USE ONLY `• REQUEST RECEIVED FROM( REQUEST NO DATE REQUEST RECEIVED TIME REQUEST RECEIVED AREAD REGIONAL CERT MUTUAL AD REQUEST FORM (Rev. 01/01 9) Revised: 02/03/2021 Area D Regional CERT Mutual Aid Plan Page 16 of 18 THIS PAGE INTENTIONALLY LEFT BLANK Revised: 02/03/2021 6Z0Z/£0/Z0 :pasinaa EVENT I INCIDENT NAME: AREA D REGION AL CERT MUTUAL AID CHECK -IN I SIGN -IN SHEET PAGE OF END TIME: DAY: S M T W TFIF S LOCATION: DATE: START TIME: Name I Cell Phone # (Print Le gibly) Signatur e Agency / Org aniz ation Assig nment In* Tim e (Use Military Tim e) O ur Total Name: :En Phone F. Nome : tell Phone Na me : .".n u P hone k N ame. :all Pho ne It N ame: tell Phone It Na me' . Se ll Phone P. Na me. Ce ll Phone It Name Cell Phone N ame: t ell P ho neP *USE MILITARY TIM E. LO G TIM E IN 15 MINUTE INCREMENTS USING .25, .50 OR . 75 Revised: 09/19/18 D CD m a 7J fD O m D O —I An • g e �z 5 to Ca 3 CD CD -0 > tt) CO CD m 0 V xi O (p co Iij Area D Regional CERT Mutual Aid Plan Page 18 of 18 THIS PAGE INTENTIONALLY LEFT BLANK Revised: 02/03/2021