• Pitkin County Incident Management Team Application and Nomination Form

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    All individuals applying for positions on the Pitkin County Incident Management Team or trainee positions must submit this nomination form annually.

    Current PCIMT members are required to submit this form to ensure correct personal information and to secure permission from your home agency.

     

    The applicant's supervisor / Chief must approve all nominations. Some Units may require a second level of approval (i.e. Fire Chief; Forest / Park FMO or State).

  • APPLICANT INFORMATION

  • EMERGENCY CONTACT INFORMATION

    Please provide a contact name and number in the event of an emergency. 

  • ICS POSITION QUALIFICATIONS

  • Please list the ICS position(s) for which you are qualified (have a completed taskbook). Be sure to note the exact month, day, and year of effective and expiration dates. Also, note if it is an NWCG or State of Colorado/All Hazards qualification.

  • TRAINEE POSITION INFORMATION

  • Please list the ICS position(s) for which you are a TRAINEE. You are considered a trainee ONLY if you have an open & current (w/in expiration period) position task book.

    You MUST indicate the exact month, day, and year you INITIATED your position task book AND the current percentage of completion below. 

    Having this accurate information allows the team coordinators to ensure you are exposed to trainee opportunities so that you gain proficiency in a position and qualification. 

  • APPLICANT POSITION OR FUNCTION INTEREST

    Using the checkboxes below, please indicate the positions within the IMT in which you are interested.

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  • TRAINING INFORMATION SECTION 

    Using the checkboxes below, please mark the courses you HAVE attended.

    AH stands for All-Hazards.

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  • INCIDENT ASSIGNMENT INFORMATION

  • Signatures / Approval

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  • The applicant must provide the permission of their supervisor / Chief, who has the authority to allow them to be away from their daily assignment for extended times. The applicant will be expected to attend assignments and team training to develop their skills as members of this regional all-hazards incident management team.

     

    Please enter the Full Name of the Supervisor/Chief and their email so that the completed form can be automatically emailed to them for approval.

  • I concur with the goals, commitment, and availability of the applicant for disaster/emergency assignments as a member of the Pitkin County Incident Management Team. The applicant has permission to leave their work assignment to participate. I also certify that the participant's basic insurance requirements (including but not limited to worker's compensation and liability) are covered by their home agency.

    ** Special note about mutual aid and reimbursable incidents:

    A majority of the incidents to which the Pitkin County Type IMT will be deployed are considered mutual aid and will follow protocols established in the Local Annual Operating Plans, or other mutual aid agreements. However, some incidents may be eligible for reimbursement depending on ownership and/or disaster declaration. In these cases, payment procedures will be established at the time of the incident.

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