124 Bull Street, Suite 140
Savannah, GA 31401
(912) 201-4500
http://cema.chathamcounty.org
Hurricane Katrina Relief Response
Hurricane Katrina Relief Response

9/1/2005    2:30 pm
Hurricane Katrina Relief Response  
 
This is for possible deployment and should not be considered a request to deploy or move towards the affected disaster area!  
 
 
Agency: _____________________________________________________  
 
Point of Contact: ________________________________________________  
 
Phone Primary ___________________________________________  
 
Phone Alternate (24 Hour) ______________________________________  
 
Specific Discipline Experts / Specialists  
 
 Fire Suppression – Career-Full Time / Non Volunteer  
 Hazardous Materials Containment (Not Clean Up)  
 Search And Rescue  
 Public Works  
 Debris Removal  
 Building Safety Engineers  
 Water and Sewer  
 Law Enforcement (Post Certified)  
 Information Technology  
 Building Construction  
 Logistics / Freight Movement (CDL)  
 Transportation Operators (Busses)  
 Paramedic – Currently Registered  
 Emergency Medical Technician (EMT) Currently Registered  
 Registered Nurse (RN) Currently Certified  
 Licensed Practical Nurse (LPN) Currently Certified  
 
 
Number of personnel your Agency is able to deploy: ______________________  
 
 
Any personnel identified for deployment in relief operations should meet the following criteria:  
 
• Be physically capable of performing manual tasks under severe conditions  
• Experienced in working with minimum supervision  
• Capable of living in austere, severe living conditions with minimal or no  
creature comforts for a period of at least 14 days  
• Free of medical condition(s) that would prevent them from working in these conditions for this period of time and,  
• Able to work within the ICS, provide basic first aid, and follow orders  
• Be able to take necessary personal protective equipment (ex. Firefighter Turnout Gear that is NFPA approved, with Self Contained Breathing Apparatus that is currently fit tested)  
 
 
 
Type of equipment your Agency is able to deploy: _____________________  
 
 
 
Amount of time these resources would be allowed to serve: _________________  
 
Amount of time necessary to prepare for deployment: _____________________  
 
 
Signature of Agency Head or Designee_______________________________________  
Date:___________________________  
 
Upon Completion: Please Fax this form to CEMA at 912-201-4504  
 
 
 
Information in the Information Release should be distributed as necessary to your partners and customers.
(If you would like this information sent to you through email, go to the CEMA website and subscribe to CEMA_Alert)