Current REP Forms

Below you will find the current forms being used by the Radiological Emergency Preparedness Program.

If you have any questions or concerns, please feel free to contact NH Homeland Security and Emergency Management Radiological Emergency Preparedness at (603) 271-2231 or rep@dos.nh.gov.

EPZ

NameCode
Emergency Worker Information Job AidFE18
EPZ RADEF Briefing CardFE18
F110D-Local Transportation Requests from Special Facilities and
Individuals		FE18
F120A Chronological Event LogFE18
F120R Local Transportation Staging Area Vehicle LogFE18
F120T Sign-in SheetFE18
F135A Potassium Iodide Acknowledgement FormFE18
RADAlert 100x Job AidMA16
  


Host

NameCode
300P Personnel Radiological Monitoring Report FormFE18
F103A Welcome to the Reception CenterFE17
F120K Emergency Vehicle Monitoring Report FormFE17
F300Q Contaminated Personal Belongings ListFE18
Geiger Muller Survey Instruments for Contamination DetectionFE17
Host Facility Background Job AidFE17
Host RADEF Briefing CardFE17
Personnel Monitoring Job AidFE17
  


STSA

Name 
F110A Transportation Resource Requests (Seabrook Station) 
F110F 8×11 Transportation Resources Chart 
F120N Transportation Log 
F125A Vehicle Assignment Form 
F125B Dispatch Order 
F125C Vehicle Registration 
F125D Vehicle Arrival Report 
F125H Transit Vehicle Log Sheet 
F300H EMS Transportation Resources Status Report/ Summary Sheet 
F301A Current Inventory Board (Seabrook Station) 
  


State

Name Code
F200A State Notification Fact SheetRev 31
300b Status Report – Seabrook Station2/25/20