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<br />I <br /> <br />FEoe",,&. EMERGENCY MANAGEMENT AGENCY <br />EXERCISE DATA (FUNCTIONAL & FULLSCALEI <br />1. flEMA REGION 2. S'TATE 3. JURISDICTION 4. FIPSCOOEt/fJrno""n,S. POPULATION <br /> <br />UAATER. FY <br /> <br />I 7, <br /> <br />6. EMA FUNDED <br />o YES 0 NO <br /> <br />I <br /> <br />LEVEL OF EXERCISE e. ACTIVATION <br />OSingle Jurisdiction o State EOC ACTIVATEO <br />DMultijurisdiction 0 VES 0 NO <br />1'0. II'URPOSE OF EXERCISE relt_ell.. "'o...y _ apply) <br /> <br />D Test Reporting Procedures <br /> <br />D Enhance Agency Coordination <br /> <br />D Validate Emergency Operations Plan IEOPI <br /> <br />o Satisy CCA Program Requiremenu (Lilt) <br />oeMA OREP OHP <br />o SARA TITLE III 0 Other <br /> <br />~OB1LE COMMAND <br />POST <br /> <br />o VES DNa <br /> <br />9. DATE.;S) OF eXERCISE <br /> <br />o Increase Awareness of Capa. <br />bilities & Vulnerabilities <br /> <br />11. Type OF EXERCISE <br /> <br />DFunctional (FE) <br /> <br />oFullscale (FSE) <br /> <br />oActual Occurance <br />(Diaaler R~,porue Que.tionnoire <br />FEMA Form 9IJ.2 .ubmitted) <br /> <br />DYes oNo <br /> <br />o Other: <br /> <br />I <br /> <br />I <br /> <br />o <br />D <br />D <br />D <br />D <br />D <br /> <br />NATURAL HAZARDS (NHI <br />Earthquake 0 Dther <br />Flood <br /> <br />o <br />o <br /> <br />t2. HAZARDS SCENARIO <br />TECHNOGICAL HAZARDS (THI <br />Civil Disorder 0 Radiological <br />HAZ MAT 0 Fire (urban) <br />Stationary 0 Transportation <br />Accident <br />o Air o,Rail <br />o Other <br /> <br />NATIONAL SECURITY INS) <br />o Attack <br />o Nuclear <br /> <br />o Conventional <br /> <br />I <br /> <br />Hurricane <br />Tornado <br />Fire (wild) <br />Winter Storm <br /> <br />o Other: <br /> <br />I <br /> <br /> <br />Federal Responders <br />Private Industry <br />Public Information <br />News Media <br />Engineering <br />Volunteer Victims <br />Other <br /> <br />I <br /> <br />IT olal Participants <br />14. FUNCTIONS EVALUATEOITESTEO (Checlr under "Y" if function performed occordi", to pIGn. "N" if it did not. Leave bIG"Jr if not te.ted) <br />YN YN YN YN <br />I - - Warning/Notification - - Law Enforcement _ _ Resource Management _ _ Search & Rescue <br />Communications Health & Medical EOC/Direction,Control Other <br />- - 0 Equipment _ _ Emergency Public Info. _ _ Transportation <br />o Interagency _ _ Damage Assessment _ _ Legal Auth. & Resp. <br />I - - Shelter _ _ Public Works Engr. EMS <br />_ _RadiOlogical Proto _ _Utilities _ _Mutal Aid <br />_ _Evacuation <br />I - Fire <br /> <br />15. ItROBl..EMS ENCOUNTERED (Ch~eIc G. many aI: 4/lPIy) <br /> <br />,1 <br /> <br />I <br /> <br />o Inadequate Disaster Plans <br />o Alert/Warning/Notification. <br />D Inadequate Training <br />D Agency Response <br />o Message Control In EOC <br /> <br />o Standard Operating Procedures <br />o Lack of Resources (Gene1'Oton. Equipment) <br />o Inadequate Crowd Control <br />o Lack of Elected Official Support <br />o Lack of Personnel <br /> <br />o Communications <br />o Inadequate Interagency Coord. <br />Other: <br /> <br />I <br /> <br />I 16. PRE.EXE RCISE TRAINING tTroin"" cou.... coodue/.d for .//h..-IO'" or 011 of tho POTtIe/pon"} <br /> <br /> . <br />0 Exercise Design 0 Exercise Briefings/Orientations 0 Effective Communications <br />D Intro. to Emerg. Mgt. 0 Emergency Planning Course 0 HAZ MAT Contingency Planning <br />D Table Top Exercise{s' 0 Leadership & Influence 0 Other <br /> <br />I". <br />I <br /> <br />REMEDIA1./FOLLOW-UP ACTION PLANeS) <br />o Update Plan. Proposed Completion (.OIoo/h6Ye.,) <br />o Other (Lu/} <br /> <br />o Additional Training (T.,..} <br /> <br />FEMA Form 95-'6. MAY 66 <br /> <br />REPLACES EDITION OF AUG 86. WHICH IS OBSOlETE. <br /> <br />{",,"tinup.,f on l'P"p~p <br />