Form Ics 211 - Incident Check-In List Template Page 4
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Block Title
Instructions
Number
16
Data Provided to
Enter the date and time that the information pertaining to that entry was
Resources Unit
transmitted to the Resources Unit, and the initials of the person who
transmitted the information.
17
Prepared by
Enter the name, ICS position/title, and signature of the person preparing
the form. Enter date (month/day/year) and time prepared (24-hour clock).
Name
Position/Title
Signature
Date/Time
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