MOHS Activity Report
Email address *
Your Name *
Your answer
Event Name *
Your answer
Start Date of Incident / Activity *
MM
/
DD
/
YYYY
Start Time of Incident / Activity *
Time
:
End Date of Incident / Activity *
MM
/
DD
/
YYYY
End Time of Incident / Activity *
Time
:
Total Number of Hours *
Your answer
Total Number of Responders? *
Your answer
Estimated Cost of Assistance.
Number of hours X cost of Man hous (Salaries), fuel, supplies, equipment broke, ect.
Estimated cost? *
Your answer
County Incident / Activity was in *
Agency assistance was given to. *
Your answer
Incident Types Involved *
Required
What type off assistance did you give? *
Required
Number of victims saved. *
Your answer
Number of fatalities. *
Your answer
Please provide a brief narrative of activity. *
Your answer
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