CIMS - Application Form

CIMS - Application Form

OHIO DEPARTMENT OF PUBLIC SAFETY
OHIO HOMELAND SECURITY
CIMS APPLICATION

DATE

11/5/2024

ALL INFORMATION IS REQUIRED UNLESS NOTED

USER CONTACT INFORMATION

FIRST NAME *	MIDDLE INITIAL	LAST NAME *	SUFFIX	JOB TITLE *
WORK PHONE * *	CELL PHONE * *	AGENCY EMAIL * *

AGENCY INFORMATION

DEPARTMENT/AGENCY/COMPANY NAME *			AGENCY ORI / FDID / IRN
ADDRESS *
STATE *	COUNTY * *	CITY * *	ZIP * *
DIRECT SUPERVISOR'S NAME *	DIRECT SUPERVISOR'S PHONE *	DIRECT SUPERVISOR'S EMAIL *
I am a Chief/CEO/Director and do not have a Direct Supervisor
I AM INVOLVED IN: Ohio Public Private Parternship (OP3) School Safety Fire Emergency Response Plan Law Emergency Response Plan Chempack Emergency Response Plan ADDITIONAL COMMENTS


Agency Name (Enter any part of the name):