pema use only control # course instruction request (cir) · 2020-02-04 · is this event law...
TRANSCRIPT
Course Instruction Request (CIR)(fillable form)
Phone Number:
Bureau of Planning, Training, and Exercise Pennsylvania Emergency Management Agency
Bureau of Planning, Training and ExercisePennsylvania Emergency Management Agency
Reviewing Signature:
PEMA USE ONLY
Type of Entity: Requesting Entity:
Date of Request:
E-mail Address:
Contact Name:
:
hazardous materials, toxic waste, or other controlled substances or materials?
"G" courses paid for with local or third party providers paid for with Task Force funds.)
Effective December 3, 2018
Control #
to to
Accept or Decline Signature:
Brief CourseDescription:
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Reason for Decline or Administrative Comments (if needed)
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1. Has an EHP been submitted for this course/event?
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2. Does this course/event only involve classroom training and does not involve any hazardous activities,
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3. Is this event Law Enforcement sensitive, or should not be publicly advertised by PEMA?
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4. Is this course included on the PEMA Training and Exercise Plan (TEP)?
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5. Do you agree to obtain PEMA's approval of instructors or course providers? (Example would include:
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6. Is your facility ADA compliant?
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Yes
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No
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NA
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EHP:
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TEP:
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Instructor Assigned:
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Add to TRAIN PA:
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Other:
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Declined:
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Accepted:
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PEMA Course Instruction Request Assessment
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Type Course:
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Other (please specify):
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Course Code & Title:
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Instruction Address:
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Secondary Date Range:
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1. Course Information
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2. Session Manager or Student Name:
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E-mail Address:
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Phone Number:
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3. Funding Source:
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Grant Program:
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Grant Year:
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Project Name:
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4. Course Costs:
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Instructor or Course Fee:
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Materials & Services:
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Travel:
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Lodging Expenditure:
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Meals & Incidentals:
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Other:
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Total Estimated Cost:
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Backfill & Overtime:
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5. Additional Information (such as instructor names)
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Course Hours:
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Primary Date Range: