Request for COMU Credentialing - Position Task Book (PTB) Submission

Iowa Credentialing for All-Hazards Communications Unit Position

Please complete this form and upload ALL completed and signed documents. DO NOT submit this form until you ensure every portion is complete and all required uploads are attached. For questions or concerns reach out to the SWIC or consult the training provided on the ISICSB website.
This is:

A new credentialing requestA renewal of a credential (required before 5 year expiration)
Position for which you are applying for credentials

COML - Communications Unit LeaderCOMT - Communications Unit TechnicianINTD - Incident Tactical DispatchterINCM - Incident Communications Center ManagerRADO - Radio OperatorAUXCOMM - Auxiliary CommunicationsITSL - IT Service Unit Leader
Name of person seeking credential in Communication Unit Position*

First NameMiddle NameLast NameSuffix
Primary Phone Number*
Alternate (back up) Phone Number - optional
Email*
example@example.com
Personal or back up Email - optional
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Rank and/or Working Title*
Agency Name*
Agency Contact Name*
Agency Contact Title*
Agency Contact Phone Number*
Agency Contact Email
example@example.com
Agency Address*

Street Address

Street Address Line 2

CityState

Zip Code
County
All Hazards Course Prerequisite Training Certificates of Completion. Per section 3.1 of the Iowa All-Hazards Communications Unit Credentialing Procedure copies of certificates of training are required documention for the application process to be considered for credenitaling. Please upload each document as required for the posiiton for which you are seeking credential. You should have the most up to date course completed on file.
Upload Certificate of Completion ICS 100 .*

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Upload Certificate of Completion IS 144 - (required for INTD credentialing)

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Upload Certificate of Completion ICS 200*

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Upload Certificate of Completion ICS 700*

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Upload Certificate of Completion ICS 800*

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Upload Certificate of Completion ICS 300 (This course is only required for COML credentialing)

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Upload Certificate of Completion ICS 400 *Not Required

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Upload a Certificate of Completion for the All-Hazards position training course for which you are applying for credential (i.e. COML, INTD, etc.)*

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Iowa All-Hazards Communications Unit Credentialing Agency Certification Credentialing Procedure - Appendix A*

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Below you will be asked to upload your completed Position Task Book (PTB). Please ensure that the Task Book is legible and contains the following completed elements.

★ All numbered tasks are initialed by appropriate approval authorities

★ Contact information is provided for each evaluator on the record of evaluations

★ The Final Evaluator's Verification is complete verifying a completed task book.

CAREFULLY review the document before submitting to the credentialing subcommittee, any errors, missing documents, signatures or markings will delay the credentialing process.

For further guidance on your PTB please see the ISICSB website for trainings and guides
Upload All-Hazards Position Task Book *

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Before I submit this form, I have:

Verified I have uploaded the correct documents aboveVerified all fields of my Position Task Book are complete with evaluators signature, initials and/or dates that coincide to events I was involved inVerified my initials are on the top of each page of my Position Task BookVerified my full name and All-Hazards Communications position is listed on every completed record of evaluation in my Position Task Book
Signature

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Iowa Credentialing for All-Hazards Communications Unit Position