ERHMS

Basic Rostering and Credentialing Example (created by the ERHMS Workgroup) Data Type Category Rostering Information
Name

Data Element
Prefix First Name Middle Initial Last Name Suffix Alias

Residence

Legal Residence Line 1 Legal Residence Line 2 City State Zip Code

E-mail Telephone Personal Attributes

Primary E-mail Primary Telephone Number Birth Date Gender Height Weight Languages Spoken Fluently

Name of Contact who will know where you are in 6 months Prefix First Name Middle Initial Last Name Suffix Alias Contact's Residence Legal Residence Line 1 Legal Residence Line 2 City State Zip Code Unique ID Number Travel Documents Union Information Unique ID Number Passport Number Union Name Local Union Number

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ERHMS
Response Organization Organization Details Employer vs. Volunteer Organization (Indicate Which) Name and Address Contact Persons Name and Telephone Number

Data Type

Category

Data Element

Credentialing Information
List of licenses and certifications with Professional Licenses and Certification application to emergency response List of successfully completed training courses with application to emergency response (may be obtained from prior ERHMS section on training)

Professional Training

Professional Education Relevant Work Experience

List of educational courses with application to emergency response (may be obtained from prior ERHMS section on training) Industry Occupation Job Task Number of Years The credential level assigned by the administrator after verification of the relevant information. (Example: Verified vs. Un-verified)

Assigned Credential Level

Assigned Credential Level

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Enhanced Rostering and Credentialing Example (created by the ERHMS Workgroup) Data Type Category Data Element Added Elements for Enhanced Rostering and Credentialing Tool
Did applicant consent to collecting, using, and maintaining the applicant's personal information? Options: Yes | No Did applicant pledge to submit only correct information into the credentialing database? Options: Yes | No

Consent

Consent to Use Information

Correct Information Pledged

Applicant Consent Date

Date applicant pledged to provide correct information and consented to the collection, use, and maintenance of the applicant's personal information. Did applicant consent to allow the state to perform background checks? Options: Yes | No

Background Check

Consent to Background Check

Date applicant consented to allow Date Consented to Background reference and background checks. Check Options Yes | No Deployment Preferences Deployment Preferences Geographical Deployment Preference Travel Distance Deployment Time Incident Type

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