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form-scco-eoc-213rr-v2.html
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form-scco-eoc-213rr-v2.html
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<!DOCTYPE html>
<html>
<head>
<meta http-equiv="Content-type" content="text/html;charset=UTF-8">
<link rel="stylesheet" type="text/css" href="resources/css/loading.css"/>
<link rel="stylesheet" type="text/css" href="resources/css/pack-it-forms.css"/>
<link rel="stylesheet" type="text/css" href="resources/css/ics-header.css"/>
<link rel="stylesheet" type="text/css" href="resources/css/ics-footer.css"/>
<link rel="stylesheet" type="text/css" href="parts/form-scco-eoc-213rr.css"/>
<script type="text/javascript" src="resources/js/pack-it-forms.js"></script>
<script type="text/javascript" src="resources/integration/integration.js"></script>
<script type="text/javascript">
integration.after("late_startup", function() {
copy_initial_value("1b.time", "23.time");
});
</script>
<meta name="pack-it-forms-pdf-URL" content="pdf/XSC_EOC-213RR_v170803_w_guide_Fillable.pdf">
<meta name="pack-it-forms-subject-suffix" content="_EOC213RR_{{field:21.incident-name}}">
<title>Resource Request Form 213RR</title>
</head>
<body>
<div class="version">2.4</div>
<%#include%>resources/html/loading.html<%/include%>
<form id="the-form" name="the-form">
<%#run%>include("resources/html/scco-header.html", {
"title": "Santa Clara County EOC Resource Request Form 213RR",
"version": "Version: 8/17<br/>PIF: {{version}}",
"to-ics-position": "Planning Section",
"to-location": "County EOC"
})
<%/run%>
<table class="nowrap-captions">
<tr>
<td>
<b>1. Incident Name</b>
<input type="text" name="21.incident-name" required="required" tabindex="21"/>
</td><td style="width:1px;">
<b>2. Date Initiated</b><br/>
<input type="text" name="22.date" required="required" tabindex="22"
class="date" value="{{date}}"/>
</td><td style="width:1px;">
<b>3. Time Initiated</b><br/>
<input type="text" name="23.time" required="required" tabindex="23"
class="time"/>
</td><td>
<b>4. Tracking Number</b>
(OA EOC)
<input type="text" name="24.tracking-number" disabled="disabled" tabindex="-1"/>
</td>
</tr><tr>
<td rowspan="2">
<b>5. Requested by</b>
<i>(name, agency, position, email, phone)</i>
<textarea name="25.requested-by" required="required" tabindex="25"
rows="9" title="name, agency, position, email, phone"></textarea>
</td><td colspan="3">
<b>6. Prepared by</b>
<i>(name, position, email, phone)</i>
<textarea name="26.prepared-by" tabindex="26"
rows="4" title="name, position, email, phone"></textarea>
</td>
</tr><tr>
<td colspan="3">
<b>7. Approved By</b>
<i>(name, position, email, phone)</i>
<textarea name="27.approved-by" tabindex="27"
rows="4" title="name, position, email, phone"></textarea>
</td>
</tr>
</table>
<table class="nowrap-captions">
<tr>
<td colspan="5" class="block-caption" style="text-align:center;">
Requesting Agency / EOC Section
<br/><span style="font-size:133%">Requested Resource Details</span>
</td>
</tr><tr>
<td style="width:6em;text-align:right;">
<b>8. Qty/Unit</b>
<textarea name="28.qty-unit" required="required" tabindex="30"
rows="4" style="text-align:right;"></textarea>
</td><td>
<b>9. Resource Description</b>
<i>(kind/type if applicable)</i>
<textarea name="29.resource-description" required="required" tabindex="31"
rows="4" title="kind/type if applicable"></textarea>
</td><td>
<b>10. Arrival</b>
<i>(date/time)</i>
<textarea name="30.resource-arrival" required="required" tabindex="32"
rows="4" title="date/time"></textarea>
</td><td>
<b>11. Priority:</b>
<select name="31.priority" required="required" tabindex="33"
style="display:block;">
<option value="" selected disabled hidden style="display:none;"></option>
<option value="Now">Now</option>
<option value="High">High (0-4 hrs.)</option>
<option value="Medium">Medium (5-12 hrs.)</option>
<option value="Low">Low (12+ hrs.)</option>
</select>
</td><td>
<b>12. Est'd Cost</b>
<textarea name="32.resource-priority" tabindex="34"
rows="4"></textarea>
</td>
</tr>
</table>
<table class="nowrap-captions">
<tr>
<td>
<b>13. Deliver to</b>
<i>(name, agency, position, email, phone)</i>
<textarea name="33.deliver-to" required="required" tabindex="35"
rows="5" title="name, agency, position, email, phone"></textarea>
</td><td>
<b>14. Location</b>
<i>(address or lat/long, site type)</i>
<textarea name="34.deliver-to-location" required="required" tabindex="36"
rows="5" title="address or lat/long, site type"></textarea>
</td>
</tr><tr>
<td colspan="2">
<b>15. Substitute/Suggested Sources</b>
<i>(name, phone, website)</i>
<textarea name="35.substitutes" tabindex="37"
rows="3" title="name, phone, website"></textarea>
</td>
</tr><tr>
<td>
<table class="same-line-label-layout">
<tr>
<th colspan="2" style="padding-bottom:1ex;">
16. Supplemental Requirements
<span style="font-weight:normal;font-style:italic;">(Include details in #17)</span>
</th>
</tr><tr>
<td>
<label class="label-sameline">
<input type="checkbox" name="36a.equipment-operator" tabindex="40"/>
Equipment Operator
</label>
</td><td>
<label>
<input type="checkbox" name="36b.lodging" tabindex="45"/>
Lodging
</label>
</td>
</tr><tr>
<td>
<label class="label-sameline">
<input type="checkbox" name="36c.fuel" tabindex="41"
onchange="on_checked(this, {'36d.fuel-type':
{enable: true, require: true, otherwise: {value: ''}}})"/>
Fuel:
<input type="text" name="36d.fuel-type" disabled="disabled" tabindex="42"
style="margin-left:0.5em;width:10em;" placeholder="type"/>
</label>
</td><td>
<label>
<input type="checkbox" name="36e.power" tabindex="46"/>
Power
</label>
</td>
</tr><tr>
<td>
<label class="label-sameline">
<input type="checkbox" name="36f.meals" tabindex="43"/>
Meals
</label>
</td><td>
<label>
<input type="checkbox" name="36g.maintenance" tabindex="47"/>
Maintenance
</label>
</td>
</tr><tr>
<td>
<label class="label-sameline">
<input type="checkbox" name="36h.water" tabindex="44"/>
Water
</label>
</td><td>
<label>
<input type="checkbox" name="36i.other" tabindex="48"
onchange="on_checked(this, {'36j.other-type':
{enable: true, require: true, otherwise: {value: ''}}})"/>
Other:
<input type="text" name="36j.other-type" disabled="disabled" tabindex="49"
style="display:inline-block;margin-left:0.5em;width:10em;"/>
</label>
</td>
</tr>
</table>
</td>
<td>
<b>17. Special Instructions</b>
<textarea name="37.instructions" rows="5" tabindex="50"></textarea>
</td>
</tr>
</table>
<%#include%>resources/html/scco-footer.html<%/include%>
</form>
<div class="print-only" style="page-break-inside:avoid;">
<div style="text-align:center;">
Santa Clara County EOC
</br><span style="font-size:125%;font-weight:bold;">Resource Request Form 213RR</span>
</div>
<br/>
<table style="border:2px solid black;">
<tr>
<td colspan="2" class="block-caption"
style="background-color:#bbeeff;border-bottom:2px solid black;font-size:125%;text-align:center;">
Completed by OA EOC or Duty Officer
</td>
</tr><tr>
<td rowspan="2" class="rotated" style="background-color:#8DB3E2;border-bottom:2px solid black;">
<div>
<div>
<span style="font-size:90%;">OA EOC</span>
<br/><span style="font-size:125%;">Plan/Intel</span>
<br/><span style="font-size:90%;">Section</span>
</div>
</div>
</td>
<td style="height:1in;"><b>18. Plan/Intel Section Remarks/Comments</b>
<i>(Include general description of request)</i></td>
</tr><tr>
<td style="height:0.5in;border-bottom:2px solid black;">
<b>19. Plan/Intel Section Chief Approval</b>
<i>(print and sign)</i>
</td>
</tr><tr>
<td rowspan="5" class="rotated" style="background-color:#F9BF8F;border-bottom:2px solid black;">
<div><div>
<span style="font-size:90%;">OA EOC</span>
<br/><span style="font-size:125%;">Logistics</span>
<br/><span style="font-size:90%;">Section</span>
</div></div>
</td>
<td style="height:0.82in;"><b>20. Order Placed By</b>
<i>(name, position, agency, phone, radio, email)</i></td>
</tr><tr>
<td style="height:0.82in;"><b>21. Method of Procurement</b>
<i>(filled-in house, agreement, purchase, etc.)</i></td>
</tr><tr>
<td style="height:0.82in;"><b>22. Supplier Name / Point-of-Contact Information</b>
<i>(name, address, phone, fax, email)</i></td>
</tr><tr>
<td style="height:1in;"><b>23. Logistics Section Remarks</b></td>
</tr><tr>
<td style="height:0.5in;border-bottom:2px solid black;">
<b>24. Logistics Section Chief Approval</b>
<i>(print and sign)</i>
</td>
</tr><tr>
<td class="rotated" style="background-color:#C2D59D;border-bottom:2px solid black;">
<div><div>
<span style="font-size:90%;">OA EOC</span>
<br/><span style="font-size:125%;">Fin/Admin</span>
<br/><span style="font-size:90%;">Section</span>
</div></div>
</td>
<td style="height:1.05in;border-bottom:2px solid black;">
<table class="same-line-label-layout">
<tr>
<th>25. Finance/Admin Remarks</th>
<th style="width:20%;">Date/Time</th>
</tr>
</table>
</td>
</tr><tr>
<td class="rotated" style="background-color:#F9BF8F;">
<div><div>
<span style="font-size:90%;">OA EOC</span>
<br/><span style="font-size:125%;">Logistics</span>
<br/><span style="font-size:90%;">Section</span>
</div></div>
</td>
<td style="height:1in;">
<table class="same-line-label-layout">
<tr>
<th>26. Logistics Section Final/Demobilization Remarks</th>
<th style="width:20%;">Date/Time</th>
</tr>
</table>
</td>
</tr>
</table>
</div>
<%#include%>resources/html/submit-buttons.html<%/include%>
</body>
</html>