Request for Utilization of Thurston County Medical Reserve Corps (MRC)

This is the request form to utilize Thurston County’s Medical Reserve Corps (MRC) for real-life events during response and recovery, drills and exercises, or for community-based events. MRC activities include but are not limited to emergency preparedness and response training and exercises, emergency shelter operations, disaster medical and behavioral health support, mass dispensing efforts, disease testing and surveillance, community vaccination clinics, support at assistance, evacuation, and reception centers, EOC support, patient movement support, first aid and medical support, community outreach and education, and more.

If you are requesting MRC for multiple events, please complete one form for per event.

Once this form is received, the MRC Coordinator will reach out confirming the receipt of your request. If the request is approved, a recruitment notification will go out to MRC volunteers for your request. You will be contacted as soon as possible regarding a status update on your request.

Please provide as much lead time as possible. Thurston County reserves the right to deny any request for utilization of our MRC. For any questions or concerns, please contact mrc@co.thurston.wa.us

Requesting Organization

Organization Name *

Associated Public Health Department/County

Name and Title of Contact Submitting Request *

Phone Number *

Email 1 *

Email 2

Physical Address of Response Site *

City *

State *

Zip Code *

Incident/Event Information

Name of Event/Incident *

Incident Number

Date of Event * +

Start Time *

End Time *

Event Location & Address *

City *

State *

Zip Code *

Please list any supplies you need Thurston County to bring to the event, if any (e.g., first-aid supplies). If you are just requesting volunteers, please state so: *

Where can volunteers park? *

Where do volunteers check-in? *

Is this an indoor or outdoor event? *

Indoor

Outdoor

Will meals, snacks, or water be provided? *

Yes, water and snacks will be provided

Yes, water, snacks, and meals will be provided

No, volunteers must bring own water and snacks

Point of Contact of who volunteers should report to upon arrival:

Full Name *

Phone Number *

Email *

Description of Volunteer Opportunity (Be specific and include information such as the type of facility, what the situation at the facility is, and what work people will be doing): *

What is the Event Objective?

If this is an overnight assignment, please provide accommodation information for the volunteers.

If this is an overnight assignment, will compensation for room and board and meals be provided?

Please provide at least 2 points of contact below:

Full Name *

Phone Number *

Email *

Full Name *

Phone Number *

Email *

Full Name

Phone Number

Staffing Resources Requested

What is the expected attendance?

Resource Description (use occupation names [RN, CAN, LPN, non-medical, etc.]) *

Quantity *

Date needed by * +

Time needed by: *

Duration *

Any other information volunteers may need to know: