State Transportation Staging Areas Quarterly Checklist

A quarterly checklist for state transportation staging areas for communities in the Emergency Planning Zone.

Name of Facility

Point of Contact

Title

Phone

Confirm email

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.

One file only.
256 MB limit.
Allowed types: gif, jpg, png, pdf, docx.

Accepted file types: gif jpg png pdf docx

Blank Flat Rate Checklist Cover Sheet.

Be sure to put this on community letterhead.

Equipment

Communications tests completed.

Telephone numbers for personnel, facilities, and agencies verified.

Inventory checks completed.

Checks of STSA equipment (other than dosimetry and meters) completed.

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

Training and Drills

All required training requested/needed completed.

Participated in drills/exercises, workshops, TTXs 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.