+------------------+---+---+-----------+---+--------------+-----------------------+
| >                |   |   |           |   |              |                       |
| **DEMOBILIZATION |   |   |           |   |              |                       |
| > CHECKOUT**     |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > 1\. Incident   |   |   |           |   | > 2\.        | > 3\. Demob. No.      |
| > Name/Number    |   |   |           |   | > Date/Time  | >                     |
| >                |   |   |           |   | >            | >                     |
| >                |   |   |           |   | >            |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > 4\.            |   |   |           |   |              |                       |
| > Unit/Personnel |   |   |           |   |              |                       |
| > Released       |   |   |           |   |              |                       |
| >                |   |   |           |   |              |                       |
| >                |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > 5\.            |   |   |           |   |              |                       |
| > Transportation |   |   |           |   |              |                       |
| > Type/No.       |   |   |           |   |              |                       |
| >                |   |   |           |   |              |                       |
| >                |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > 6\. Actual     |   |   |           | > |              |                       |
| > Release        |   |   |           |   |              |                       |
| > Date/Time      |   |   |           | 7 |              |                       |
| >                |   |   |           | \ |              |                       |
| >                |   |   |           | . |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | M |              |                       |
|                  |   |   |           | a |              |                       |
|                  |   |   |           | n |              |                       |
|                  |   |   |           | i |              |                       |
|                  |   |   |           | f |              |                       |
|                  |   |   |           | e |              |                       |
|                  |   |   |           | s |              |                       |
|                  |   |   |           | t |              |                       |
|                  |   |   |           | ? |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | Y |              |                       |
|                  |   |   |           | e |              |                       |
|                  |   |   |           | s |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | N |              |                       |
|                  |   |   |           | o |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | N |              |                       |
|                  |   |   |           | u |              |                       |
|                  |   |   |           | m |              |                       |
|                  |   |   |           | b |              |                       |
|                  |   |   |           | e |              |                       |
|                  |   |   |           | r |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > 8\.            |   |   |           | > |              |                       |
| > Destination    |   |   |           |   |              |                       |
| >                |   |   |           | 9 |              |                       |
| >                |   |   |           | \ |              |                       |
|                  |   |   |           | . |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | N |              |                       |
|                  |   |   |           | o |              |                       |
|                  |   |   |           | t |              |                       |
|                  |   |   |           | i |              |                       |
|                  |   |   |           | f |              |                       |
|                  |   |   |           | i |              |                       |
|                  |   |   |           | e |              |                       |
|                  |   |   |           | d |              |                       |
|                  |   |   |           | : |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | A |              |                       |
|                  |   |   |           | g |              |                       |
|                  |   |   |           | e |              |                       |
|                  |   |   |           | n |              |                       |
|                  |   |   |           | c |              |                       |
|                  |   |   |           | y |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | R |              |                       |
|                  |   |   |           | e |              |                       |
|                  |   |   |           | g |              |                       |
|                  |   |   |           | i |              |                       |
|                  |   |   |           | o |              |                       |
|                  |   |   |           | n |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | A |              |                       |
|                  |   |   |           | r |              |                       |
|                  |   |   |           | e |              |                       |
|                  |   |   |           | a |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | D |              |                       |
|                  |   |   |           | i |              |                       |
|                  |   |   |           | s |              |                       |
|                  |   |   |           | p |              |                       |
|                  |   |   |           | a |              |                       |
|                  |   |   |           | t |              |                       |
|                  |   |   |           | c |              |                       |
|                  |   |   |           | h |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | N |              |                       |
|                  |   |   |           | a |              |                       |
|                  |   |   |           | m |              |                       |
|                  |   |   |           | e |              |                       |
|                  |   |   |           | : |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           | D |              |                       |
|                  |   |   |           | a |              |                       |
|                  |   |   |           | t |              |                       |
|                  |   |   |           | e |              |                       |
|                  |   |   |           | : |              |                       |
|                  |   |   |           | > |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > 10\. Unit      |   |   |           |   |              |                       |
| > Leader         |   |   |           |   |              |                       |
| > Responsible    |   |   |           |   |              |                       |
| > for Collecting |   |   |           |   |              |                       |
| > Performance    |   |   |           |   |              |                       |
| > Rating         |   |   |           |   |              |                       |
| >                |   |   |           |   |              |                       |
| >                |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > 11\.           |   |   |           |   |              |                       |
| > Unit/Personnel |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > You and your   |   |   |           |   |              |                       |
| > resources have |   |   |           |   |              |                       |
| > been released  |   |   |           |   |              |                       |
| > subject to     |   |   |           |   |              |                       |
| > sign off from  |   |   |           |   |              |                       |
| > the following: |   |   |           |   |              |                       |
| >                |   |   |           |   |              |                       |
| > *Demob. Unit   |   |   |           |   |              |                       |
| > Leader check   |   |   |           |   |              |                       |
| > the            |   |   |           |   |              |                       |
| > appropriate    |   |   |           |   |              |                       |
| > box*           |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Logistics      |   |   |           |   |              |                       |
| > Section        |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Supply Unit    | > |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Communications | > |   |           |   |              |                       |
| > Unit           |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Facilities     | > |   |           |   |              |                       |
| > Unit           |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Ground Support | > |   |           |   |              |                       |
| > Unit Leader    |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Planning       |   |   |           |   |              |                       |
| > Section        |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Documentation  |   |   | >         |   |              |                       |
| > Unit           |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Finance        |   |   |           |   |              |                       |
| > Section        |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Time Unit      |   | > |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
|                  |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > Other          |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| >                |   |   | >         |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| >                |   |   | >         |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+
| > 12\. Remarks   |   |   |           |   |              |                       |
| >                |   |   |           |   |              |                       |
| >                |   |   |           |   |              |                       |
+------------------+---+---+-----------+---+--------------+-----------------------+

+-----------------------------------------------------------------------+
| > 13\. Prepared by (include Date and Time)                            |
| >                                                                     |
| >                                                                     |
+-----------------------------------------------------------------------+

+-----+-----------------+----------------------------------------------+
| **  |                 |                                              |
| Ins |                 |                                              |
| tru |                 |                                              |
| cti |                 |                                              |
| ons |                 |                                              |
| for |                 |                                              |
| c   |                 |                                              |
| omp |                 |                                              |
| let |                 |                                              |
| ing |                 |                                              |
| the |                 |                                              |
| De  |                 |                                              |
| mob |                 |                                              |
| ili |                 |                                              |
| zat |                 |                                              |
| ion |                 |                                              |
| Ch  |                 |                                              |
| eck |                 |                                              |
| out |                 |                                              |
| (   |                 |                                              |
| ICS |                 |                                              |
| f   |                 |                                              |
| orm |                 |                                              |
| 221 |                 |                                              |
| )** |                 |                                              |
|     |                 |                                              |
| Pr  |                 |                                              |
| ior |                 |                                              |
| to  |                 |                                              |
| act |                 |                                              |
| ual |                 |                                              |
| De  |                 |                                              |
| mob |                 |                                              |
| Pl  |                 |                                              |
| ann |                 |                                              |
| ing |                 |                                              |
| S   |                 |                                              |
| ect |                 |                                              |
| ion |                 |                                              |
| (De |                 |                                              |
| mob |                 |                                              |
| Un  |                 |                                              |
| it) |                 |                                              |
| sho |                 |                                              |
| uld |                 |                                              |
| ch  |                 |                                              |
| eck |                 |                                              |
| w   |                 |                                              |
| ith |                 |                                              |
| the |                 |                                              |
| C   |                 |                                              |
| omm |                 |                                              |
| and |                 |                                              |
| St  |                 |                                              |
| aff |                 |                                              |
| (L  |                 |                                              |
| iai |                 |                                              |
| son |                 |                                              |
| Of  |                 |                                              |
| fic |                 |                                              |
| er) |                 |                                              |
| to  |                 |                                              |
| det |                 |                                              |
| erm |                 |                                              |
| ine |                 |                                              |
| any |                 |                                              |
| age |                 |                                              |
| ncy |                 |                                              |
| sp  |                 |                                              |
| eci |                 |                                              |
| fic |                 |                                              |
| ne  |                 |                                              |
| eds |                 |                                              |
| r   |                 |                                              |
| ela |                 |                                              |
| ted |                 |                                              |
| to  |                 |                                              |
| de  |                 |                                              |
| mob |                 |                                              |
| and |                 |                                              |
| re  |                 |                                              |
| lea |                 |                                              |
| se. |                 |                                              |
| If  |                 |                                              |
| a   |                 |                                              |
| ny, |                 |                                              |
| add |                 |                                              |
| to  |                 |                                              |
| l   |                 |                                              |
| ine |                 |                                              |
| Num |                 |                                              |
| ber |                 |                                              |
| 11. |                 |                                              |
+-----+-----------------+----------------------------------------------+
| I   | Item Title      | Instructions                                 |
| tem |                 |                                              |
| No. |                 |                                              |
+-----+-----------------+----------------------------------------------+
| 1\. | Incident        | Enter Name and/or Number of Incident.        |
|     | Name/No.        |                                              |
+-----+-----------------+----------------------------------------------+
| 2\. | Date & Time     | Enter Date and Time prepared.                |
+-----+-----------------+----------------------------------------------+
| 3\. | Demob. No.      | Enter Agency Request Number, Order Number,   |
|     |                 | or Agency Demob Number if applicable.        |
+-----+-----------------+----------------------------------------------+
| 4\. | Unit/Personnel  | Enter appropriate vehicle or Strike          |
|     | Released        | Team/Task Force ID Number(s) and Leader's    |
|     |                 | name or individual overhead or staff         |
|     |                 | personnel being released.                    |
+-----+-----------------+----------------------------------------------+
| 5\. | Transportation  | Enter Method and vehicle ID number for       |
|     |                 | transportation back to home unit. Enter N/A  |
|     |                 | if own transportation is provided.           |
|     |                 | *Additional specific details should be       |
|     |                 | included in Remarks, block \# 12.*           |
+-----+-----------------+----------------------------------------------+
| 6\. | Actual Release  | To be completed at conclusion of Demob at    |
|     | Date/Time       | time of actual release from incident. *Would |
|     |                 | normally be last item of form to be          |
|     |                 | completed.*                                  |
+-----+-----------------+----------------------------------------------+
| 7\. | Manifest        | Mark appropriate box. If yes, enter manifest |
|     |                 | number. *Some agencies require a manifest    |
|     |                 | for air travel.*                             |
+-----+-----------------+----------------------------------------------+
| 8\. | Destination     | Enter the location to which Unit or          |
|     |                 | personnel have been released. *i.e. Area,    |
|     |                 | Region, Home Base, Airport, Mobilization     |
|     |                 | Center, etc.*                                |
+-----+-----------------+----------------------------------------------+
| 9\. | Area/Agency/    | Identify the Area, Agency, or Region         |
|     |                 | notified and enter date and time of          |
|     | Region Notified | notification.                                |
+-----+-----------------+----------------------------------------------+
| 1   | Unit Leader     | Self-explanatory. *Not all agencies require  |
| 0\. | Responsible for | these ratings.*                              |
|     | Collecting      |                                              |
|     | Performance     |                                              |
|     | Ratings         |                                              |
+-----+-----------------+----------------------------------------------+
| 1   | Resource        | Demob Unit Leader will identify with a check |
| 1\. | Supervision     | in the box to the left of those units        |
|     |                 | requiring check-out. Identified Unit Leaders |
|     |                 | are to initial to the right to indicate      |
|     |                 | release.                                     |
|     |                 |                                              |
|     |                 | Blank boxes are provided for any additional  |
|     |                 | check, (unit requirements as needed), i.e.   |
|     |                 | Safety Officer, Agency Rep., etc.            |
+-----+-----------------+----------------------------------------------+
| 1   | Remarks         | Any additional information pertaining to     |
| 2\. |                 | demob or release.                            |
+-----+-----------------+----------------------------------------------+
| 1   | Prepared by     | Enter the name of the person who prepared    |
| 3\. |                 | this Demobilization Checkout, including the  |
|     |                 | Date and Time.                               |
+-----+-----------------+----------------------------------------------+