Natural Disaster Incident Report Form Page 2
Download a blank fillable Natural Disaster Incident Report Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Natural Disaster Incident Report Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4PWS Name:
PWS ID#:
2
Incident Name:
Incident ID#:
Critical customers (List):
Being Served (Yes/No)? __
1. _________________________________________________________________
2. _________________________________________________________________
3. _________________________________________________________________
4. _________________________________________________________________
(Examples: Hospitals, Industries, Emergency Response Facilities, etc.)
OPERATOR INFORMATION
What are the water system’s current staffing levels?
Category
Normal Staffing Level
Current Staffing Level
Operators (certified)
Operators (not certified)
Administrative
Information Technology
GENERATOR
Does the system have back-up generation?
_Yes
_No
_Some
_Don’t know
How many generators does the system have? _____________________
Are generators currently in use:
_Yes _No _Don’t know
Fuel Type:
# of Days Supply:
Fuel Storage Capacity:
Do the generators allow the entire system to operate?
_Yes _No
_Don’t know
If No, Explain: ____________________________________________________________________
How long each day do you run each generator? __________________________________________
SOURCES
Name
Type
Condition
_ GW
_ SW
_ GW
_ SW
_GW
_ SW
This template report was provided via the U.S. EPA's website on Federal Funding for Utilities - Water/Wastewater - in National Disasters (Fed FUNDS).
For further information, please visit
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business