Toggle search form
Search for:
Toggle navigation
Homeland Security Emergency Management
Home
Grants
EMPG Resources
EMPG Application
HMEP Grant Resources and Information
Hazard Mitigation Assistance Grant Resources and Information
Training & Exercise Grants
Warm Zone EMS Grant
Public Information
EMD Resource Templates
HSEM Quarterly Newsletter
ReadyNH.gov
See Something, Say Something
REP
EPZ Quarterly Checklist
Host Quarterly Checklist
STSA Quarterly Checklist
Seabrook Station Assessment
REP Training
Do You Require Evacuation Assistance In An Emergency?
PDAFN List Revision Numbers
Current REP Forms
2021 Seabrook Station Brochure
Planning
Public Assistance
Continuity of Operations
State Hazard Mitigation Plan
Commodities Distribution Annex
Local Emergency Operations Plan (LEOP) Resource Documents
Facility Self-Assessment Tool
Local Hazard Mitigation Planning
Threat & Hazard Identification and Risk Assessment (THIRA) / Stakeholder Preparedness Review (SPR)
Schools
School Brochures and Pamphlets
School EOP Development Tools
School Resource Officer (SRO) Conference
School Reunification Game
EOP Workshop
Order See Something, Say Something for Schools Materials
NH School Safety Resource Center
WebEOC Resources
WebEOC User Guide
Training & Exercise
About Training & Exercise Services
Training & Exercise Grants
Training & Exercise Grant Guidance
Training & Exercise Homeland Security Grant Application
Training & Exercise Controller, Evaluator & Instructor Grant Application
Training & Exercise Homeland Security Grant Reimbursement
Exercises
Upcoming Exercises
Exercise Application (Non-Grant)
Exercise Resources
School Reunification Game
Equipment Request
Training
Training Policy & Guidance
Training Request
Available Training
Course Resources
Houses of Worship Resources
New Hampshire Tactical Officers Association
Multi-Year Training & Exercise Plan Survey
Contact Us
Internship Program
Variable Message Signs (VMS)
Return to
REP
Host Quarterly Checklist
Community
*
Dover
Rochester
Manchester
Community
Point of Contact
*
Title
*
Phone
*
Email
*
Enter Email
Confirm Email
Which quarter are you reporting?
*
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.
*
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
.
Be sure to put this on community letterhead.
EOC
Equipment:
1. Communications tests completed.
*
Date Format: MM slash DD slash YYYY
2. Telephone numbers for personnel, facilities, and agencies verified.
*
Date Format: MM slash DD slash YYYY
3. Inventory checks completed.
*
Date Format: MM slash DD slash YYYY
4. Checks of Equipment (other than dosimetry and meters) completed.
*
Date Format: MM slash DD slash YYYY
5. Checks of dosimetry (Re-zeroing) and meters (checking background). Any equipment issues, report to RIMC.
*
Date Format: MM slash DD slash YYYY
Training and Drills:
1. All required training requested/needed completed.
*
Date Format: MM slash DD slash YYYY
2. Training plan for next year completed and approved by REP Planning (On Assessment Request).
*
Date Format: MM slash DD slash YYYY
3. Drills/Exercise Plan for next year completed and approved by REP Planning (On assessment request).
*
Date Format: MM slash DD slash YYYY
4. Participated in drills/exercises, workshops, TTXs as required.
*
Date Format: MM slash DD slash YYYY
REP Annual Update:
1. Any alterations, including relocation, of facilities reported to REP Planning.
*
Date Format: MM slash DD slash YYYY
2. Map accuracy checked.
*
Date Format: MM slash DD slash YYYY
3. Signatory page of REP plan signed by appropriate municipal official when elections held.
*
Date Format: MM slash DD slash YYYY
4. Any Local Letters of Agreement reviewed and updated.
*
Date Format: MM slash DD slash YYYY
5. Plan and procedures reviewed and comments noted. Forwarded to REP Planning.
*
Date Format: MM slash DD slash YYYY
6. Any roadway changes due to maintenance, construction, or other projects reported to REP Planning.
*
Date Format: MM slash DD slash YYYY
Budgets:
1. Annual assessment request prepared and forwarded to HSEM by March 15th.
*
Date Format: MM slash DD slash YYYY
RECEPTION CENTER
Equipment:
1. Communications tests completed.
*
Date Format: MM slash DD slash YYYY
2. Telephone numbers for personnel, facilities, and agencies verified.
*
Date Format: MM slash DD slash YYYY
3. Inventory checks completed.
*
Date Format: MM slash DD slash YYYY
4. Checks of Reception Center Equipment (other than dosimetry and meters).
*
Date Format: MM slash DD slash YYYY
5. Checks of dosimetry (re-zeroing) and meters (checking background). Any equipment issues reported to RIMC.
*
Date Format: MM slash DD slash YYYY
6. Assembly and functional check of Portal monitor completed.
*
Date Format: MM slash DD slash YYYY
Training and Drills:
1. All required training requested/needed completed.
*
Date Format: MM slash DD slash YYYY
2. Participated in Drills/exercises, Workshops, TTXs as required.
*
Date Format: MM slash DD slash YYYY
REP Annual Update:
1. Facilities inspected for any alterations, including relocation. Report to REP Planning.
*
Date Format: MM slash DD slash YYYY
2. Any Local Letters of Agreement reviewed and updated.
*
Date Format: MM slash DD slash YYYY
VERIFICATION & CERTIFICATION:
I certify that I am an authorized representative of the aforementioned community.
*
Yes
Statement of Acknowledgement
*
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.
In this section
REP
EPZ Quarterly Checklist
Host Quarterly Checklist
REP 101 Online Training Navigation
STSA Quarterly Checklist
Quick Links
DR 4516 – COVID-19 Public Assistance
First Responder COVID-19 Stipend Program
Available Training
Course Resources
DOS Joint Loss Management Committee
EMD Resource Templates
EMPG Resources
Facility Self-Assessment Tool
Hazard Mitigation
Houses of Worship Resources
Internship Program
NH School Safety Resource Center
Public Assistance
See Something, Say Something
Variable Message Signs (VMS)