• Pitkin County Incident Management Team Application and Nomination Form

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  • Pitkin County Incident Management Team Application and Nomination Form

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

    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).

  • 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 a NWCG or FEMA / Colorado All Hazards.

  • Trainee Positions:

    If you have an open taskbook as a trainee please indicate what percentage of the tasks are completed.

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  • Training Needs Assessment: 

    Please mark the below listed courses you have attended and the date. If you attended a wildland (NWCG) equivalent course please mark it in the All-Hazards course area. The course number may be an L, E or P listing; AH stands for All-Hazard. If you would like to attend the course mark that box.

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  • 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 AHIMT.

     

    Please enter the Full Name of the Supervisor/Chief as well as 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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