SoM Emergency Response Team

SoM Emergency Response Team - Application

Personal Information

Last Name*

First Name*

E-mail Address*

Cell Phone Number*

Work Desk Phone Number

Organization*

Select

Department/Unit*

Position*

Building Name

Address*

Floor Number*

Building Number - Alternate Work Site

Address - Alternate Work Site

Floor Number - Alternate Work Site

Summarize your emergency response training and/or experience.

Including: CPR, First Aid, EMT/MD, Ham Radio, Search & Rescue, CERT, FEMA online ICS. Please include dates.

How did you find out about the ERT program?

What do you expect to gain from the ERT program?

Emergency Response Team Commitment

Please attach your signed and completed Emergency Response Team Commitment here.

If you are unable to attach it, please email completed form to somemergency@stanford.edu

Drag and drop files here or

Steps to complete ERT Training:

Watch the recorded ERT Training here.
Complete the ERT Quiz here. You must pass with a score of at least 80%. You may retake the quiz if you do not pass the first time.
Register for and attend in-person Stryker Evacuation Training. Register here.

Send me a copy of my responses