Catastrophic Emergency Response Request
Emergency Contact
Contact Info
Full Names of Everyone in Your Household
*
County
*
Alcona
Alger
Allegan
Alpena
Antrim
Arenac
Baraga
Barry
Bay
Benzie
Berrien
Branch
Calhoun
Cass
Charlevoix
Cheboygan
Chippewa
Clare
Clinton
Crawford
Delta
Dickinson
Eaton
Emmet
Genesee
Gladwin
Gogebic
Grand Traverse
Gratiot
Hillsdale
Houghton
Huron
Ingham
Ionia
Iosco
Iron
Isabella
Jackson
Kalamazoo
Kalkaska
Kent
Keweenaw
Lake
Lapeer
Leelanau
Lenawee
Livingston
Luce
Mackinac
Macomb
Manistee
Marquette
Mason
Mecosta
Menominee
Midland
Missaukee
Monroe
Montcalm
Montmorency
Muskegon
Newaygo
Oakland
Oceana
Ogemaw
Ontonagon
Osceola
Oscoda
Otsego
Ottawa
Presque Isle
Roscommon
Saginaw
Sanilac
Schoolcraft
Shiawassee
St. Clair
St. Joseph
Tuscola
Van Buren
Washtenaw
Wayne
Wexford
Email
*
Phone
*
Alternate Phone
PKTF Radio Number (if you have one)
Your Location. Be as specific as possible.
*
Type of Emergency
Type of Emergency
*
Wildfire
Widespread Flooding
Tornado
Long-term Power Outage
Ice
Sleeper Cell Activated
Testing Only
Other Emergency
Approximately how many people are affected?
Nature of communication access available
What is your current status?
My status is...
*
I am safe and in need of nothing.
I am OK, but could use some supplies.
I am in danger! Need help ASAP.
What do you need?
Food
Water
Pet Supplies
Baby food
Baby Formula
Diapers
Blankets
Transportation
Shelter
Fuel
Generators
Heaters
Refrigeration
Chain Saws
Tarps
Radios
Repeaters
Flotation Devices
Matches/Lighters
First Aid Kit
Extension Cords
Propane
Cooking Supplies
Communication Devices
Clothing
Medications
Medical Supplies
Other (if you need to add more detail of what you need)
Community Organizations Offering Support
Organization Name
Location
Support being offered
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Add
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Remove
Community Organizations Needing Supplies
Organization Name
Location
Supplies Needed
Contact
Phone #
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Add
minus1
Remove
Report any criminal activity
Describe any criminal activity you have witnessed first hand:
Upload images of evidence
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Anything else?
Please share any additional information as desired...
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