RIDMAT/MRC is a state-based 501 (c) 3 non-profit organization

Our objective is to bridge you in your continued pursuit for fulltime staff. Our volunteer team is meant to provide you relief from your emergency staffing shortages. You must continue to find fulltime staff. All sites MUST have a site coordination visit prior to mission activation.

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* 1. Please provide the following request information.

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* 2. Please provide the following facility information.

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* 3. Do you have an adequte supply of the below PPE? Select all that are in supply.

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* 4. Do you have a separate Donning and Doffing area at the facility?

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* 5. Do you have a procedure in place for exposures?

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* 6. What is your current staffing situation? Select all that apply.

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* 7. Are you actively seeking new paid staff?

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* 8. What attempts are you making to acquire paid staff? Select all that apply.

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* 9. Enter the number of each volunteer role requested per shift. Please note a detailed staffing request form will be sent to you during the vetting process.

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* 10. Which shifts are you requesting assistance with? Please note a detailed staffing request form will be sent to you during the vetting process.

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* 11. When is the requested start of these needs?

Date
Time

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* 12. When is the anticipated end date of these needs?

Date
Time

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* 13. Do you have the ability to provide a virtual site tour? Please note that all mission requests must have a site visit before becoming active (virtually or in person).

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* 14. REPORTING STRUCTURE: Describe the reporting structure for the mission and how the individual(s) will be expected to operate within this structure.

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* 15. OTHER: Please provide any other information that may be important for the mission.

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