Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service
Application Form
OMB Control #0648-0419
Expires 06/30/2006
NOTE
:
Please contact the Warning Coordination Meteorologist (WCM) at your local National Weather Service Forecast Office (WFO)
prior
to submitting this application at:
http://www.stormready.noaa.gov/contact.htm
. This will ensure the correct WFO indentifier and that the application had been configured for use at the local WFO. To identify the proper WFO ID click on "
WFO
" here or below left.
Community Information
WFO
WFO
ABQ
ABR
AFC
AFG
AJK
AKQ
ALY
AMA
APX
ARX
BGM
BIS
BMX
BOI
BOU
BOX
BRO
BTV
BUF
BYZ
CAE
CAR
CHS
CLE
CRP
CTP
CYS
DDC
DLH
DMX
DTX
DVN
EAX
EKA
EPZ
EWX
EYW
FFC
FGF
FGZ
FSD
FWD
GGW
GID
GJT
GLD
GRB
GRR
GSP
GUM
GYX
HFO
HGX
HNX
HUN
ICT
ILM
ILN
ILX
IND
IWX
JAN
JAX
JKL
LBF
LCH
LIX
LKN
LMK
LOT
LOX
LSX
LUB
LWX
LZK
MAF
MEG
MFL
MFR
MHX
MKX
MLB
MOB
MPX
MQT
MRX
MSO
MTR
OAX
OHX
OKX
OTX
OUN
PAH
PBZ
PDT
PHI
PIH
PQR
PSR
PUB
RAH
REV
RIW
RLX
RNK
SEW
SGF
SGX
SHV
SJT
SJU
SLC
STO
TAE
TBW
TFX
TOP
TSA
TWC
UNR
VEF
County
City/Town
Population
Primary Point of Contact
Secondary Point of Contact
Name
Name
Office
Office
Title
Title
Mailing
Address
Mailing Address
City
City
State
State
ZIP
ZIP
Phone
Phone
e-mail
e-mail
Communications
Location of 24 Hour Warning Point
Location of Emergency Operations Center
Renewal Comments:
Date:
Initials:
NWS Information Reception Equipment
Warning Point
#Required______ #Verif______
EOC
#Required______ #Verif______
NOAA Weather Radio (Required if in range)
NOAA Weather Radio (Required if in range)
NOAA Weather Wire (Subscription)
NOAA Weather Wire (Subscription)
EMWIN
EMWIN
Law Enforcement Teletype (LETS)
Law Enforcement Teletype (LETS)
Amateur Radio
Amateur Radio
Pagers* (Warning reception)
Pagers* (Warning reception)
Television (Local network or cable TV)
Television (Local network or cable TV)
Radio (AM/FM) - EAS reception
Radio (AM/FM) - EAS reception
NAWAS
NAWAS
Internet (Subscription for alerts):
Internet (Subscription for alerts):
Commericial Data Service:
Commericial Data Service:
Other*
Other*
Other*
Other*
*Capabilities needing explanation:
Renewal Comments:
Date:
Initials:
Local Weather & Water Monitoring Equipment
Warning Point
#Required______ #Verif______
EOC
#Required______ #Verif______
Anemometer (Wind gauge)
Anemometer (Wind gauge)
Rain Gauge
Rain Gauge
River Gauge
River Gauge
Locally owned Radar
Locally owned Radar
Internet Radar Source:
Internet Radar Source:
Internet Weather Station:
Internet Weather Station:
TV Radar Source:
TV Radar Source:
Other*
Other*
Other*
Other*
*Capabilities needing explanation:
Renewal Comments:
Date:
Initials:
Local Warning Dissemination
Warning Point
#Required______ #Verif______
EOC
#Required______ #Verif______
Outdoor Warning Siren(s)
Outdoor Warning Siren(s)
Cable TV Override
Cable TV Override
Plan for Sirens on Emergency Vehicles
Plan for Sirens on Emergency Vehicles
Telephone Tree for Criticial Facilities
Telephone Tree for Criticial Facilities
Local Alert Broadcast System*
Local Alert Broadcast System*
Local Pager System* (dissemination)
Local Pager System* (dissemination)
Coordinated Area-Wide Radio Network*
Coordinated Area-Wide Radio Network*
Local Flood Warning System*
Local Flood Warning System*
Other*
Other*
Other*
Other*
*Capabilities needing explanation:
Renewal Comments:
Date:
Initials:
Local Government Owned Buildings with Public Access
Office
Location or Address
Tone Alert NOAA
Weather Radio
Comments
Warning Point
EOC
City Hall
School Superintendent
Renewal Comments:
Date:
Initials:
Community Preparedness
Annual Safety Talks
#Required______ #Verif______
Date
Topic
Location
Speaker
1
2
3
4
5
Weather Radio Purchase Program
Has your community/county developed a program to subsidize the purchase of Specific Area Message Encoder (SAME) equipped Weather Radios for its citizens? (not required)
Yes
No
If yes, provide details:
Other Community Preparedness Activities
Date
Topic
Location
Organizer
1
2
3
4
5
Renewal Comments:
Date:
Initials:
Administrative Tools/Record Keeping
Renewal
Formal Hazardous Weather Operations Plan
Yes
Yes
Procedure for reporting storm/tsunami damage to the local National Weather Service Office in real-time
Yes
Yes
EOC Activation Procedures
Yes
Yes
Spotter Activation Criteria
Yes
Yes
Local Warning System(s) Activation Criteria
Yes
Yes
Warning Point personnel has authority to activate Warning System (written)
Yes
Yes
Spotter Roster and Training Record
Yes
Yes
Last Visit by Emergency Manager to NWS Office
Date:
Date:
Last Visit by NWS Officials to Community
Date:
Date:
Last NWS Spotter Training for Spotters and Dispatchers
Date:
Date:
Last NWS Spotter Training Hosted/Co-Hosted (For populations >40,000)
Date:
Date:
Exercises (topics):
Date:
Date:
Renewal Comments:
Date:
Initials:
Additional Information
List any additional descriptions, narratives, or documentation below. If the information applies to a specific part of the form, please indicate which part.
Applying Official
Application Submitted by:
Date:
Office:
Title:
On submission of your application, the National Weather Service Office (WFO) you selected will be notified and your form sent to them. Also, you will be given the opportunity to print out your application to keep for your records.