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| Your Name:* |
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| Your Call:* |
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| Your E-mail Address:* |
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| Your District:* |
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| Report for Month of:* |
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| Report for Year of:* |
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| Total Members:* |
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| Change from last report:* |
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| Members with NIMS training: |
(Number that have completed IS-700) |
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| Net Frequency:* |
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| Net Name: |
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| NTS Liaison to where? |
(MSN, CWTN, TWN, etc.) |
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| Number of weekly nets:* |
(usually 4 or 5) |
| Man hours for weekly nets:* |
(check-ins*hours, total for month) |
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| Number of nets/drills:* |
(not weekly, not PSE and not Emergency, 0 if none) |
| Man hours for all nets/drills:* |
(check-ins*hours, total for month, 0 if none) |
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| Number of Public Service events:* |
(enter 0 if none) |
| Public Service hours:* |
(check-ins*hours, total for month, 0 if none) |
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| Number of Emergency Incidents:* |
(enter 0 if none) |
| Emergency - Man hours:* |
(check-ins*hours, total for month, or 0 if none) |
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| Total number of events: |
OPTIONAL - Total number of nets from above. |
| Total Man Hours: |
OPTIONAL - Total hours from above. |