RAPID RESPONSE TEAM APPLICATION & SKILLS DATA BASE

RAPID RESPONSE TEAM APPLICATION & SKILLS DATA BASE

FDEM Area:

Name: Last ____________________________ First ______________________________ MI _______

County
Office Phone and Cell Phone
Office Fax
Email Address
EOC Contact Number
Years of EM Experience
Disaster Related Experience	Position	Event
EOC Management
Disaster Field Office
Wilderness Search & Rescue
High Level Rescue
Volunteer Coordination
Donations Management
Damage Assessment
Public Information Officer
Urban Search and Rescue
Fixed Nuclear Facility Emergency Operations
Logistics Staging Operation
Base Camp Operations
Incident Command
SERT Liaison
Response Liaison
Mutual Aid Coordination
Comfort Station Operations
Mobile Command Post Operations
Communications Center Operations
ESF 5 Operations
Name: Last ____________________________ First ______________________________ MI _______

EMERGENCY MANAGEMENT TRAINING	DATE
Rapid Response Team Orientation
Incident Command System
Principles of Emergency Management
Disaster Response and Recovery Operations
EOC Management and Operations
ICS/EOC Interface
Managing Emergency Operations
Damage Assessment
Debris Management
Decision making and Problem Solving
Resource Management

Name: Last ____________________________ First ______________________________ MI _______

SPECIALIZED TRAINING/CERTIFICATION	DATE
Public Information Officer
Donations Management
Hazardous Materials Technician
FEPA Associate Emergency Manager (FAEM)
FEPA Professional Emergency Manager (FPEM)
Certified Emergency Manager (CEM)

Name: Last ____________________________ First ______________________________ MI _______

Supervisor Approval
I certify I have read the State of Florida Rapid Response Team Procedures and reviewed said procedures with the applicant. By signing below I provide my permission, as his/her supervisor, for this individual, named in this application, to be considered for assignment to the State Emergency Operations Center during times of need. I further understand that each instance of this special duty assignment will be approved by me prior to the named individual being released to perform such duty.
Signature below	Date

Printed name and title