TsunamiReady application from

Print Form
Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service

Application Form
OMB Control # 0648-0419
Expires 06/30/2009

Community Information
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; ZIP

State; ZIP

Phone

Phone

e-mail

e-mail

Guideline 1:
Location of 24-Hour Warning Point

Communications
Location of Emergency Operations Center

Verification Team General Notes:

Renewal Comments:

Date:

Initials:

Note: Please do not write in shaded areas.
Public reporting burden for this collection of information is estimated to average two hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other suggestions for reducing this burden to Donna Franklin, National Weather Service, 1325 East West Highway,
Room 14456, Silver Spring, MD, 20910.
Statement on confidentiality. Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected to a
penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of
information displays a currently valid OMB Control Number.

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Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service

Application Form
OMB Control # 0648-0419
Expires 06/30/2009

Guideline 2:
Warning Point

NWS Information Reception Equipment
# Required_____

# Verif_____

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) ____________

Commercial Data Service_________________

Commercial Data Service________________

Other*_________________________________

Other*________________________________

Other*_________________________________

Other*________________________________

Verif

List any additional capabilities on a separate sheet
*Capabilities needing explanation:

Verification Team Notes:

Renewal Comments:

Date:

Initials:

Note: Please do not write in shaded areas.

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Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service

Application Form
OMB Control # 0648-0419
Expires 06/30/2009

Guideline 3:
Warning Point

Local Warning Dissemination
# Required_____

# Verif_____

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

Local Alert Broadcast System*

Local Alert Broadcast System*

Local Pager System* (For dissemination)

Local Pager System* (For dissemination)

Telephone Tree to Critical Facilities

Telephone Tree to Critical Facilities*

Coordinated Area-Wide Radio Network*

Coordinated Area-Wide Radio Network*

Local Flood Warning System*

Local Flood Warning System*

Other*_____________________________

Other*________________________________

Other*_____________________________

Verif

Other*________________________________

List any additional capabilities on a separate sheet
*Capabilities needing explanation:

Verification Team Notes:

Renewal Comments:

Date:

Initials:

Note: Please do not write in shaded areas.

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Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service

Application Form
OMB Control # 0648-0419
Expires 06/30/2009

Local Government-Owned Buildings in Which Public Traffic is Common
Office

Location or Address

Tone Alert NOAA
Weather Radio

Verif

Comments

Warning Point
EOC
City Hall
School Superintendent

Verification Team Notes:

Renewal Comments:

Date:

Initials:

Note: Please do not write in shaded areas.

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Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service

Application Form
OMB Control # 0648-0419
Expires 06/30/2009

Guideline 4:

Community Preparedness
Annual Safety Talks

Date

# Required_____

Topic

# Verif_____

Location

Speaker

1
2
3
4
5
List any additional safety talks on a separate sheet
Verif

Community Tsunami Awareness Program
Designate/establish tsunami shelter/area in safe zone.
Designate tsunami evacuation areas and evacuation routes, and install evacuation route signs.
Provide written, locally specific tsunami hazard response material to public.
Encourage schools to implement a tsunami hazard curriculum, practice evacuations, and provide safety material
to staff and students.
Number of annual tsunami awareness campaigns:___________________________________

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

Activity

Location

Organizer

1
2
3
List any additional activities on a separate sheet
Renewal Comments:

Date:

Initials:

Note: Please do not write in shaded areas.

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Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service

Guideline 5:

Application Form
OMB Control # 0648-0419
Expires 06/30/2009

Verif

Administrative Tools/Record Keeping

Renewal

Formal Tsunami Hazard and Hazardous Weather Operations Plan
• Procedure for reporting storm/tsunami damage to the local National
Weather Service Office in real-time
• EOC Activation Procedures
• Spotter Activation Criteria
• Local Warning System(s) Activation Criteria

Yes
Yes

Yes
Yes

Yes
Yes
Yes

Yes
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

Biennial

Last Visit by NWS Officials to Community

Annual

Last NWS Spotter Training for Spotters and Dispatchers

Biennial

Last NWS Spotter Training Hosted/Co-Hosted (For populations >40,000)
Exercises

Annual
Date:

Date:

Topic(s):

List any additional descriptions, narratives, or documentation on a separate sheet
Verification Team Notes:

Renewal Comments:

Date:

Initials:

Signature of Applying Official
Application Submitted by (print name):

Office:

Title:

Signature:

Date:

NWS Personnel Receiving Application (print name):

Date Received:

Note: Please do not write in shaded areas.

Page 6

Department of Commerce
National Oceanic &
Atmospheric Administration
National Weather Service

Application Form
OMB Control # 0648-0419
Expires 06/30/2009

Site Verification Team Signatures
Print Name:

Office:

Title:

Signature:

Date:

Print Name:

Office:

Title:

Signature:

Date:

Print Name:

Office:

Title:

Signature:

Date:

Print Name:

Office:

Title:

Signature:

Date:

Signature in Renewal Year
Application Submitted by: (print name):

Office:

Title:

Signature:

Date:

NWS Personnel Receiving Application (print name):
Date Received:

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