SETRAC Technology Training/User Request Form

Please complete all required fields. Failure to complete the appropriate fields will result in your account not being established and a future training date must be attended as accounts must be created in advance and NOT the day of the training.

What Day are you registering for?*

Only choose the Special Class Registration if you were instructed to do so. Failure to select a proper date will result in notification errors. If you do not already have an account then 24-48 hours prior to the class you will receive an activation link from Juvare for your account set-up. A link for the training will also be sent 24-48 hours prior to the training.

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail (must be a work-based email address)*

Ex: john.doe@houstonmethodist.org (can not be GMail, Yahoo, ICloud, AOL, Hotmail, etc)

Job Title*

Employer*

SPECIAL NOTES: Memorial Hermann System please email emergency.preparedness2@memorialhermann.org. Dialysis Centers please visit the below link for account access: https://app.smartsheet.com/b/form/f9f8ea67056d4397baa9c6d1dac23b75

Which applications do you need access to?*

EMResourceWebEOC

Do you currently have a WebEOC Account*

YesNoI do not require access to WebEOC

Do you currently have an EMResource Account*

YesNoI do not require access to EMResource

What is your username?*

Example: JohnsonChris6772

Facility / Agency*

SPECIAL NOTES: Memorial Hermann System please email emergency.preparedness2@memorialhermann.org. Dialysis Centers please visit the below link for account access: https://app.smartsheet.com/b/form/f9f8ea67056d4397baa9c6d1dac23b75

Name of your Direct Supervisor*

Single or Multiple Facilities*

SingleMultiple - Lisa Spivey will contact you

Provide four numbers*

These cannot be sequential. These digits will be part of your user name (i.e DoeJohn2468)

E-mail of your Direct Supervisor*

If you selected EMResource, what access level is needed?*

UpdateView Only (EMResource only)

Update: Ability to change the status of a facility and run reports.

View Only: Has access, but unable to change the facility status or run reports.