HICS-213

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ka1vgm
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Location: Keene, NH

HICS-213

Post by ka1vgm » Mon Mar 19, 2018 2:07 am

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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
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<head>
  <meta http-equiv="CONTENT-TYPE" content="text/html; charset=utf-8">
  <title>HICS-213</title>
  <meta name="AUTHOR" content="w1hkj">
  <meta name="CREATED" content="20111028">
  <META NAME="EDITABLE" CONTENT="true">
  <META NAME="MENU_ITEM" CONTENT="HICS-213">
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  <table border="1" cellpadding="2" cellspacing="0" width="100%">
    <col width="16%">
    <col width="16%">
    <col width="16%">
    <col width="52%">
    <tbody>
      <form>
        <tr valign="top">
          <td colspan="4">
            <p class=F3><b>HICS-213 – INCIDENT MESSAGE FORM</b></p>
          </td>
        </tr>
        <tr valign="top">
          <td colspan="3">
            <p class=F2><b>1. FROM (Sender):</b><br><input name="1" value="" size="40" maxlength="" class="in1" id="" type="text"></p>
          </td>
          <td>
            <p class=F2><b>2. TO (Receiver):</b><br><input name="2" value="" size="40" maxlength="" class="in1" id="" type="text"></p>
          </td>
        </tr>
        <tr valign="top">
          <td>
            <p class=F2><b>3. DATE RECEIVED</b></p>
          </td>
          <td>
            <p class=F2><b>4. TIME RECEIVED</b></p>
          </td>
          <td>
            <p class=F2><b>5. RECEIVED VIA</b></p>
          </td>
          <td>
            <p class=F2><b>6. REPLY REQUESTED:</b></p>
          </td>
        </tr>
        <tr valign="top">
          <td>
            <p class=F2><input name="3" value="" size="15" maxlength="" class="in1" id="" type="text"></p>
          </td>
          <td>
            <p class=F2><input name="4" value="" size="15" maxlength="" class="IN1" id="" type="text"></p>
          </td>
          <td>
            <table border="0" cellpadding="1" cellspacing="0" width="100%">
              <col width="10%">
              <col width="40%">
              <col width="10%">
              <col width="40%">
              <tr>
                <td><b></b></td>
                <td><input name="5" value="Phone" type="radio" class="" id="5a">Phone</td>
                <td><b></b></td>
                <td><input name="5" value="Radio" type="radio" class="" id="5b">Radio</td>
              </tr>
            </table>
          </td>
          <td>
            <table border="0" cellpadding="1" cellspacing="0" width="100%">
              <col width="20%">
              <col width="5%">
              <col width="15%">
              <col width="5%">
              <col width="15%">
              <col width=40%>
              <tr>
                <td>
                  <p class=F2>Reply</p>
                </td>
                <td>
                  <p class=F2><b></b></p>
                </td>
                <td>
                  <p class=F2><input name="6" value="Yes" type="radio" class="" id="6a">Yes</p>
                </td>
                <td>
                  <p class=F2><b></b></p>
                </td>
                <td>
                  <p class=F2><input name="6" value="No" type="radio" class="" id="6b">No</p>
                </td>
              </tr>
            </table>
          </td>
        </tr>
        <tr valign="top">
          <td colspan="2"><br>
          </td>
          <td>
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
              <col width="10%">
              <col width="40%">
              <col width="10%">
              <col width="40%">
              <tr>
                <td><b></b></td>
                <td><input name="5" value="Other" type="radio" class="" id="5c">Other</td>
              </tr>
            </table>
          </td>
          <td>
            <p class=F2><b>If YES, REPLY TO:</b><input name="6a" value="" size="35" maxlength="" class="in1" id="" type="text"></p>
          </td>
        </tr>
    </tbody>
  </table>
  <br>
  <table border="1" cellpadding="2" cellspacing="0" width="100%">
    <col width="15%">
    <col width="3%">
    <col width="20%">
    <col width="3%">
    <col width="20%">
    <col width="3%">
    <col width="20%">
    <col width="16%">
    <tbody>
      <tr>
        <td>
          <p class=F2><b>7. PRIORITY</b></p>
        </td>
        <td>
          <p class=F2><b><input name="7" value="High" type="radio" class="" id="7a" ></b></p>
        </td>
        <td>
          <p class=F2>Urgent - High</p>
        </td>
        <td>
          <p class=F2><b><input name="7" value="Medium" type="radio" class="" id="7b"></b></p>
        </td>
        <td>
          <p class=F2>Non Urgent – Medium</p>
        </td>
        <td>
          <p class=F2><b><input name="7" value="Low" type="radio" class="" id="7c"></b></p>
        </td>
        <td>
          <p class=F2>Informational - Low</p>
        </td>
      </tr>
    </tbody>
  </table>
  <br>
  <table border="1" cellpadding="4" cellspacing="0" width="100%">
    <tbody>
      <tr>
        <td>
          <p class=F2><b>8. MESSAGE</b> (KEEP ALL MESSAGES / REQUESTS BRIEF, TO THE POINT, AND VERY SPECIFIC):</p>
          <textarea name="8" rows="2" cols="140" class="ta1" id=""> </textarea><pre><p class=F4></p></pre></td>
      </tr>
      <tr>
        <td>
          <p class=F2><b>9. ACTION TAKEN</b> (if any):<br></p>
          <textarea name="9" rows="3" cols="140" class="ta1" id=""> </textarea> <pre><p class=F4></p></pre></td>
      </tr>
    </tbody>
  </table>
  <br>
  <table border="1" cellpadding="4" cellspacing="0" width="100%">
    <col width="30%">
    <col width="20%">
    <col width="50%">
    <tbody>
      <tr valign="top">
        <td>
          <p class=F2><b>Received by:</b></p>
        </td>
        <td>
          <p class=F2><b>Time Received:</b></p>
        </td>
        <td>
          <p class=F2><b>Forward to:</b></p>
        </td>
      </tr>
      <tr>
        <td>
          <p class=F2><input name="receviedby1" value="" size="35" maxlength="" class="in1" id="" type="text"><br></p>
        </td>
        <td>
          <p class=F2><input name="timereceived1" value="" size="15" maxlength="" class="in1" id="" type="text"></p>
        </td>
        <td>
          <p class=F2><input name="fowardto1" value="" size="60" maxlength="" class="in1" id="" type="text"></p>
        </td>
      </tr>
      <tr>
        <td colspan="3">
          <p class=F2><b>Comments:</b></p>
          <pre><p class=F4><textarea name="comments1" rows="3" cols="140" class="ta1" id="" value=""> </textarea></p></pre></td>
      </tr>
    </tbody>
  </table>
  <br>
  <table border="1" cellpadding="4" cellspacing="0" width="100%">
    <col width="30%">
    <col width="20%">
    <col width="50%">
    <tbody>
      <tr valign="top">
        <td>
          <p class=F2><b>Received by:</b></p>
        </td>
        <td>
          <p class=F2><b>Time Received:</b></p>
        </td>
        <td>
          <p class=F2><b>Forward to:</b></p>
        </td>
      </tr>
      <tr>
        <td>
          <p class=F2><input name="receviedby2" value="" size="35" maxlength="" class="in1" id="" type="text"><br></p>
        </td>
        <td>
          <p class=F2><input name="timereceived2" value="" size="15" maxlength="" class="in1" id="" type="text"></p>
        </td>
        <td>
          <p class=F2><input name="fowardto2" value="" size="60" maxlength="" class="in1" id="" type="text"></p>
        </td>
      </tr>
      <tr>
        <td colspan="3">
          <p class=F2><b>Comments:</b><br></p>
          <pre><p class=F4><textarea name="comments2" rows="3" cols="140" class="ta1" id="" value=""> </textarea></p></pre></td>
      </tr>
    </tbody>
  </table>
  <br>
  <table border="1" cellpadding="4" cellspacing="0" width="100%">
    <tbody>
      <tr>
        <td>
          <p class=F2><b>10. FACILITY NAME</b><br><input name="10" value="" size="130" maxlength="" class="IN1" id="" type="text"></p>
        </td>
      </tr>
    </tbody>
  </table>
  </form>
  </body>

</html>
--
Larry Levesque
Senior Business Systems Analyst
Granite City Electric Supply Inc.
617-221-1551 Direct
857-753-1407 Cell

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