MV CERT/EOC MESSAGE FORM
PacFORMS adaption of SCCo ICS Form 213 By Phil Henderson, KF6ZSQ
(This form works with Outpost/OpDirect for Automatic ASCII text save)

JAVASCRIPT IS NOT ENABLED IN THIS BROWSER.
THIS FORM WILL NOT WORK WITHOUT JAVASCRIPT ENABLED.

For Instructions using this form       For a list of CERT Areas
2.) When Receiving Msg.:
Sender's msg. #

Unlock msg. nos. 2 & 3 		Msg. #

RED Areas Required

 3.) When Sending Msg.:
Receiver's msg. #
1a.) Date: (MM/DD/YY)
 4.) Situation Severity (Select One)
EMERGENCY
      (e.g., Life Threat)
URGENT
      (e.g., Property Threat)
OTHER
      (All Others)
 5.) Msg. Handling Order (Select One)
  IMMEDIATE
        (As Soon as Possible)
  PRIORITY
        (Less Than One Hour)
  ROUTINE
        (More Than One Hour)
 6.) Message Requests You to:
      TAKE ACTION (Check one)
           Yes     No
      REPLY (Check one)
Yes, by   No
        FOR YOUR INFO.
        (No action required)
1b.) Time: (24 hr. time)
0001 to 2400
2:00 PM = (2+12)=1400 Hrs.
To: 7.) ICS Position: (required)
From: 8.) ICS Position: (required)
9a.) Location: (required) 9b.) Location: (required)
Name: (optional) Name: (optional)
Telephone #: (optional) Telephone #: (optional)
10.) SUBJECT:      

11.) REFERENCE (e.g., Number of earlier msg.):

12a.) MESSAGE: Fill in the boxes with your current Damage Assessment column TOTALS and perentage of Neighborhoods
surveyed at this time. For "Fires", report only ACTIVELY burning fires.
Fires HazardBuilding PeopleRoadsOtherNeighborhood
FiresGas LeakWater LeakElectrical Chemical LightModHeavyImmediate DelayedTrappedMorgueAccessNo access % Surveyed

12b.) MORE INFO:   Enter the top 1 to 3 of the Priority 1 DA incidents with locations and details; and describe "Other" (if greater than 0)

13.) Action Taken: (For use by Originator / Recipient)   -> USE SEPARATE MESSAGE FORM IF SENDING REPLY!
CC: Management       Operations       Planning       Logistics       Finance
14.) Operator use Only
Relay:    Rcvd:       Sent:
How Received   or   Sent   (Check One this line and one below)
  Telephone                Dispatch Center
  EOC Radio               FAX           Courier
  Amateur Radio         Other
Operator Call Sign:  
Operator Name:  
Date:   Time:     Date/Time updated at Submit
Outgoing (Sent):
Message Originator: Send one copy to Radio, one to PLANNING, retain a copy for originators file.
Radio: After sending, complete Action Taken info. in gray area, keep a copy for file in Radio.
Incoming (Received):
Radio: After receiving, complete Action Taken info. in gray area, route one copy to the addressee, one copy to PLANNING; retain a copy for file in Radio.
Addressee; Take approriate action.
Below you will see two SUBMIT buttons. The one on the left, when Submitted, will open a new window with the ASCII text so you can manually capture, copy, paste and save the text. Follow instructions in red in that window.

The SUBMIT button to the right will automatically transfer the ASCII text extracted from the form to the Outpost database via via OpDirect. OpDirect must be running to make this work or nothing is saved.