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Fast Track

Houston SAME

PO BOX 460407
Houston, TX 77056
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FastStart Interactive Questionnaire

The purpose of this questionnaire is to maintain the Post database of member firms with capabilities needed by various local and federal government agencies in responding to a civil or military emergency. You can also download a PDF file of the form from the menu bar.

1.0 ADMINISTRATIVE DATA

Firm Name:*
Street Address:*
Mailing Address:*
Website Address:
Primary Point of Contact Information*
Please enter the following contact information: NAME, POSITION, PHONE, CELL, FAX, EMAIL ADDRESS(ES)
Alternate Point of Contact Information
Please enter the following contact information: NAME, POSITION, PHONE, CELL, FAX, EMAIL ADDRESS(ES)
1a. Has your firm previously completed this survey?*
If No, please skip to question 2 and complete the survey.
1b. If Yes, has any information changed since your last update?
If No, please stop and return this page only. If Yes, please complete remainder of survey and return all pages.

2.0 FIRM CATEGORY

Please indicate which category below most closely describes your firm:*

3.0 FIRM CAPABILITIES

Support Code 1: Transportation: Highways, streets, bridges, railroads, airports, marine
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply):
Support Code 2: Communications: Telecommunications Assets
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply):
Support Code 3: Public Works & Engineering: restoration, engineering, planning, designing, construction, and demolition.
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply):
Support Code 4: Fire Fighting: management, coordination, detection, and suppression
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply):
Support Code 5: Information and Planning: collection, evaluation, and processing
Please indicate whether your firm has capabilities in this field available 'in house'
Support Code 6: Mass Care: shelter, feeding, first aid, information, bulk distribution
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply):
Support Code 7: Resource Support: evaluation, location, procurement of material resources, stock surplus
Please indicate whether your firm has capabilities in this field available 'in house'
Support Code 8: Health & Medical Services: public health response, triage, treatment, transportation and evacuation of patients.
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply):
Support Code 9: Urban Search & Rescue: immediate lifesaving response, use and coordination of specialized equipment and teams, coordination of federal aircraft
Please indicate whether your firm has capabilities in this field available 'in house'
Support Code 10: Hazardous Materials: Coordinate response to potential HAZMAT discharges; prevent/minimize/mitigate threats to public health, welfare, or the environment.
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply). If Other, Please Specify in General Comments Section
Support Code 11: Food: obtain thorough loan, donation, or direct acquisition, arrange for transportation to staging areas.
Please indicate whether your firm has capabilities in this field available 'in house'
Support Code 12: Energy: Coordinate provision of emergency power and fuel to support response operations; assess energy system damage, energy supply, demand and requirements to restore systems.
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply):
Equipment
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply):
Materials
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply):
Other (please specify in the general comments section)
Please indicate which of the following capabilities your firm has available 'in house' (Check all that apply) and specify area of experience in comments section
General Comments Section for Firm Capabilities

4.0 FIRM EXPERIENCE

Please indicate which of the following operations/emergencies your firm has had experience with:
Check all that apply

5.0 SUGGESTIONS

Do you have any suggestions as to how S.A.M.E. can provide additional help to local governments in responding to civil/military emergencies?

6.0 ADDITIONAL INFORMATION OR CONCERNS

What obstacles/concerns do you have in participating in a federal/local government response to an emergency (i.e. F.A.R. requirements, liability, time required to complete formal contract, time required to receive payments, government chain of command)?
What additional information do you need to be able to better respond to civil/military emergencies?

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