Form Ics 211 - Incident Check-In List Template Page 3
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Block Title
Instructions
Number
Check-In Information
Self explanatory.
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List single resource
Enter the following information for resources:
personnel (overhead) by
OPTIONAL: Indicate if resource is a single resource versus part of Strike
agency and name, OR list
Team or Task Force. Fields can be left blank if not necessary.
resources by the following
format
Use this section to list the home State for the resource.
State
Use this section to list agency name (or designator), and individual
Agency
names for all single resource personnel (e.g., ORC, ARL, NYPD).
Use this section to list the resource category based on NIMS, discipline,
Category
or jurisdiction guidance.
Use this section to list the resource kind based on NIMS, discipline, or
Kind
jurisdiction guidance.
Use this section to list the resource type based on NIMS, discipline, or
Type
jurisdiction guidance.
Use this section to enter the resource name or unique identifier. If it is a
Resource Name or
Strike Team or a Task Force, list the unique Strike Team or Task Force
Identifier
identifier (if used) on a single line with the component resources of the
Strike Team or Task Force listed on the following lines. For example, for
an Engine Strike Team with the call sign “XLT459” show “XLT459” in this
box and then in the next five rows, list the unique identifier for the five
engines assigned to the Strike Team.
Use ST or TF to indicate whether the resource is part of a Strike Team or
ST or TF
Task Force. See above for additional instructions.
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Order Request #
The order request number will be assigned by the agency dispatching
resources or personnel to the incident. Use existing protocol as
appropriate for the jurisdiction and/or discipline, since several incident
numbers may be used for the same incident.
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Date/Time Check-In
Enter date (month/day/year) and time of check-in (24-hour clock) to the
incident.
Leader’s Name
For equipment, enter the operator’s name.
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Enter the Strike Team or Task Force leader’s name.
Leave blank for single resource personnel (overhead).
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Total Number of Personnel
Enter total number of personnel associated with the resource. Include
leaders.
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Incident Contact
Enter available contact information (e.g., radio frequency, cell phone
Information
number, etc.) for the incident.
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Home Unit or Agency
Enter the home unit or agency to which the resource or individual is
normally assigned (may not be departure location).
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Departure Point, Date and
Enter the location from which the resource or individual departed for this
Time
incident. Enter the departure time using the 24-hour clock.
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Method of Travel
Enter the means of travel the individual used to bring himself/herself to
the incident (e.g., bus, truck, engine, personal vehicle, etc.).
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Incident Assignment
Enter the incident assignment at time of dispatch.
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Other Qualifications
Enter additional duties (ICS positions) pertinent to the incident that the
resource/individual is qualified to perform. Note that resources should not
be reassigned on the incident without going through the established
ordering process. This data may be useful when resources are
demobilized and remobilized for another incident.
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