Element Completion Sign-Off
State Homeland Security Grant Program Part II
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Element Completion Sign-Off State Homeland Security Grant Program Part II |
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District Name |
District ID No. |
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Building Name
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Building No. |
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Address |
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City |
Zip |
County |
Each element signoff must include school official AND fire chief (designee) OR police chief (designee) OR local emergency manager.
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Element One – Vulnerability Assessment |
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I certify that this element was completed for the above cited building location as prescribed in the grant agreement. |
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Name of School Official (printed) |
Title of School Official |
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Signature of School Official |
Date |
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Name of Documenting Agency (print) |
Agency Official Name (print) |
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Signature of Agency Official |
Date |
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Element Two – Hazardous Response Plan Update |
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I certify that this element was completed for the above cited building location as prescribed in the grant agreement. |
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Name of School Official (printed) |
Title of School Official |
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Signature of School Official |
Date |
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Name of Documenting Agency (print) |
Agency Official Name (print) |
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Signature of Agency Official |
Date |
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Element Three – Training Exercise (tabletop, full-scale) |
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I certify that this element was completed for the above cited building location as prescribed in the grant agreement. |
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Name of School Official (printed) |
Title of School Official |
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Signature of School Official |
Date |
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Name of Documenting Agency (print) |
Agency Official Name (print) |
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Signature of Agency Official |
Date |