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REP
EPZ Quarterly Checklist
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Which quarter are you reporting?
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1 Qtr: July - Sept
2 Qtr: Oct - Dec
3 Qtr: Jan - March
4 Qtr: April - June
SIGNED COVER SHEET:
Please upload your SIGNED flat rate checklist cover sheet.
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Drop files here or
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl.
A blank cover sheet can be found at this link.
Flat Rate Checklist Cover Sheet
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Be sure to put this on community letterhead.
Please upload your Persons with Disabilities and Access/Functional Needs (PDAFN) List
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Drop files here or
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl.
EQUIPMENT:
1. Communications tests completed.
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2. Telephone numbers for personnel, facilities, and agencies verified.
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3. Inventory checks completed.
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4. Checks of EOC equipment (other than dosimetry and meters) completed.
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5. Checks of dosimetry (Re-zeroing) and meters (checking background). Any equipment issues, report to RIMC.
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Training and Drills:
1. All required training requested/needed completed.
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2. Training plan for next year completed and approved by REP Planning (On Assessment Request).
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3. Drills/Exercise Plan for next year completed and approved by REP Planning (On assessment request).
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4. Participated in drills/exercises, workshops, TTXs as required.
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REP Annual Update:
1. Any alterations, including relocation, of facilities reported to REP Planning.
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2. Map accuracy checked for traffic/access control points.
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3. Schools, day cares, and other special facilities identified and transportation needs updated. (In consult with Special Facilities Field Rep.)
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4. Signatory page of the REP Plan signed by appropriate municipal official when elections held.
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5. Any local letters of agreement reviewed and updated.
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6. Plans and procedures reviewed and comments noted. Comments forwarded to REP Planning.
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7. Any roadway changes due to maintenance, construction, or other projects reported to REP Planning.
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PDAFN List:
1. Listing of citizens with disabilities and access/functional needs updated and verified. COMPLETED listing forwarded to REP Planning.
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Budgets:
1. Annual assessment request prepared and forwarded to HSEM by March 15th.
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VERIFICATION & CERTIFICATION:
I certify that I am an authorized representative of the aforementioned community.
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Yes
Statement of Acknowledgement
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By writing my full name below and clicking the submit button, I am attesting that the information I provided in this form is true and accurate to the best of my ability. I also acknowledge that failure to provide accurate and/or misleading information may be grounds for disqualification.
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