SANTA CLARA COUNTY LOGISTICS REQUEST FORM
 JavaScript Version for Packet Transmission
Note: This Form has been adapted from the paper form to prepare an ASCII text file for transmission via Amateur Radio Packet.
Form adapted by Phil Henderson, KF6ZSQ, Mountain View, CA AEC.
Ver. 2.4.7, 02/13/12 - PacRELEASE 3.7
(For the manual saving of the ASCII output, this form is best used with Microsoft Internet Explorer)

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< Items in RED are required >
TO:  LOGISTICS       A.) When Receiving Msg.,
Senders's Msg. No. 		      B.) Msg. Number      
Unlock msg. nos. A) & C) 		C.) When Sending Msg.,
Receiving Msg. No. 		                                                         
D.) Situation Severity (Select One)
EMERGENCY  (e.g., Life Threat)
URGENT  (e.g., Property Threat)
OTHER  (All Others)
 E.) Msg. Handling Order (Select One)
  IMMEDIATE   (As Soon as Possible)
  PRIORITY   (Less Than One Hour)
  ROUTINE   (More Than One Hour)
 F.) Message Requests You to:
      REPLY (Check one)
Yes, by   No
REQUESTING AGENCY INFORMATION
2. REQUESTING AGENCY/ORGANIZATION:
3. POINT OF CONTACT:
4. POC PHONE NO.: 5. EOC POC: 6. APPROVED BY:
7. DATE/TIME OF REQUEST
(mm/dd/yyyy @ hhmm -24 hour time)
 8. LOCAL INCIDENT NUMBER
 9. LOCAL REQUEST NO. (If Applicable)

INFORMATION ABOUT RESOURCES REQUIRED
10. DESCRIPTION OF RESOURCES REQUIRED
 11. QUANTITY:
12. WHY NEEDED? TO DO WHAT? 13. HOW LONG NEEDED:

REPORTING/DELIVERY INSTRUCTIONS
14. WHEN NEEDED? DATE/TIME
(mm/dd/yyyy @ hhmm -24 hour time)
 15. DELIVER TO (NAME/TITLE):
 16. PHONE:
17. DELIVERY LOCATION:
18. BEST LOCAL ACCESS ROUTE:

THE FOLLOWING SECTION IS FILLED OUT WHEN RESOURCES ARE RECEIVED

31. DELIVERY TIME/DATE: 32. VERIFIED BY:
33. REMARKS:
34. FINANCE REMARKS/TRACKING:

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