TO: W7OEM
CC: K7VV;KE7NIY
From: <Callllsign>
Subj: <Callsign> - <DateTime> - REQUEST

Msg:
Request for Assistance Report

______________________________________________________________________________

TO:                   Oregon Emergency Management
POSITION:             Duty Officer

______________________________________________________________________________

FROM:                 (person with authority to request assistance
POSITION:             

______________________________________________________________________________

SUBJECT:             Request for Assistance and Incident Number
DATE/TIME:           <DateTime>               

______________________________________________________________________________

MESSAGE:

1.	JURISDICTION (COUNTY):    Yamhill                     

2.	DATE AND TIME OF REQUEST:  <DateTime>                        

3.	REQUESTING ORGANIZATION OR AGENCY:

4.	BRIEF DESCRIPTION OF PROBLEM:

5.	BRIEF DESCRIPTION OF KINDS OF MATERIALS, EQUIPMENT OR PERSONNEL REQUESTED:

6.	DELIVERY LOCATION:                         

7.	DATE/TIME REQUIRED AT LOCATION:                          

8.	SPECIAL REPORTING REQUIREMENTS (SUCH AS ROUTE):                        

9.	ESTIMATED DURATION TO COMPLETE TASK:                         

10.	WHO IS DELIVERY POINT OF CONTACT:                         

11.	HOW CAN DELIVERY POINT OF CONTACT BE CONTACTED:                         





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S-SIGNATURE: /S/
POSITION:                          

______________________________________________________________________________


REPLY:                          

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DATE/TIME:                          
S-SIGNATURE: /S/                          
POSITION:                          

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Oregon Emergency Management Request for Assistance Version 2.1 Revised 24 August 2013