Host Quarterly Checklist

A quarterly checklist for Emergency Planning Zone reception center hosts.

Community

Point of Contact

Title

Phone

Which quarter are you reporting?

1 Qtr: July - Sept

2 Qtr: Oct - Dec

3 Qtr: Jan - March

4 Qtr: April - June

Signed Cover Sheet

Please upload your Signed flat rate checklist cover sheet.

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Blank Flat Rate Checklist Cover Sheet.

Be sure to put this on community letterhead.

Emergency Operations Center

Equipment

Communications tests completed.

Telephone numbers for personnel, facilities, and agencies verified.

Inventory checks completed.

Checks of Equipment (other than dosimetry and meters) completed.

Checks of dosimetry (Re-zeroing) and meters (checking background). Any equipment issues, report to RIMC.

Training & Drills

All required training requested/needed completed.

Participated in drills/exercises, workshops, tabletop exercises, as required.

Radiological Emergency Preparedness Annual Update

Any alterations, including relocation, of facilities reported to REP Planning.

Map accuracy checked.

Any Local Letters of Agreement reviewed and updated.

Any roadway changes due to maintenance, construction, or other projects reported to Radiological Emergency Preparedness Planning.

Reception Center

Equipment

Communications tests completed.

Telephone numbers for personnel, facilities, and agencies verified.

Inventory checks completed.

Checks of Reception Center Equipment (other than dosimetry and meters).

Checks of dosimetry (re-zeroing) and meters (checking background). Any equipment issues reported to RIMC.

Training & Drills

All required training requested/needed completed.

Participated in drills/exercises, workshops, tabletop exercises, as required.

Radiological Emergency Preparedness Annual Update

Facilities inspected for any alterations, including relocation. Report to Radiological Emergency Preparedness Planning.

Any Local Letters of Agreement reviewed and updated.

Verification & Certification

I certify that I am an authorized representative of the aforementioned community.

Yes

Statement of Acknowledgement

By writing my full name below and clicking the submit button, I am attesting that the information I provided in this form is true and accurate to the best of my ability. I also acknowledge that failure to provide accurate and/or misleading information may be grounds for disqualification.