APPENDIX II-7

Environmental Emergency Response Alert
Request for WMO RSMC Support by Delegated Authority


This form should be sent by fax to the RSMC. At the same time, the Delegated Authority must immediately call the RSMC to confirm the transmission of this request for RSMC support.

(This section must be completed in full)
STATUS: ..................................................... (EVENT OR EXERCISE)  Date/time of request: ........................................ (UTC)

NAME OF DELEGATED AUTHORITY: .................................................................................................................................

COUNTRY: .....................................................................................................................................................................

DELEGATED AUTHORITY TELEPHONE/FAX NUMBERS: (.........) ................................................................................ (Tel.)

							           	          (.........) ................................................................................ (Fax)

REPLY TELEPHONE/FAX NUMBERS FOR NMS OF
REQUESTING COUNTRY:				      	       (.........) ................................................................................ (Tel.)

							                          (.........) ................................................................................ (Fax)

NAME OF RELEASE SITE: ....................................................................................................................... (facility and place)

GEOGRAPHICAL LOCATION OF RELEASE: ..................................................................................... (lat./long. deg. + minutes)
																				("N or S; E or W")



(essential accident information for model simulation - if not available, model will execute with standard default values)
RELEASE CHARACTERISTICS:

START OF RELEASE: ................................................................................................................................... (date/time, UTC)

DURATION: ...................................................... (hours), or end of release .................................................. (date/time, UTC)

RADIONUCLIDE SPECIES: ...................................................................................................................................................

TOTAL RELEASE QUANTITY: ............................................................................................................................. (Becquerel)

OR POLLUTANT RELEASE RATE: .................................................................................................................. (Becquerel/hour)

EFFECTIVE HEIGHT OF RELEASE:	Surface: ............................................................................................................... or

                                                       stack height: .................................................................................................. (m), or

                                                       aloft: top .................................................. (m), base ............................................ (m)



(helpful information for improved simulation)
SITE ELEVATION: .............................................................................................................................................................. (m)

LOCAL METEOROLOGICAL CONDITIONS NEAR ACCIDENT: ............................................................................................

..............................................................................................................................................................................................

..............................................................................................................................................................................................

............................................................................................................ (wind speed and direction/weather/cloudiness, etc.)

OTHER INFORMATION: ..........................................................................................................................................................

..............................................................................................................................................................................................

..............................................................................................................................................................................................

.................................................................................................. (nature of accident, cause, fire explosion, controlled release,

											foreseeable development, normal activity, projected conditions, etc.)



(to be completed by RSMC)
DATE/TIME OF RECEIPT OF REQUEST: ....................................................................................................................... (UTC)

DATE/TIME OF RETURN CONFIRMATION OF RECEIPT: ............................................................................................... (UTC)

Note: All times in UTC

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