Using the HICS Tools in Incident Action Planning - The 2012 ...

Using the HICS Tools in
Incident Action Planning
CRAIG DEATLEY PA- C
DIRECTOR, INSTITUTE FOR PUBLIC HEALTH
EMERGENCY READINESS
WASHINGTON HOSPITAL CENTER
PH: 202- 257- 4714
CRAIG.DEATLEY@MEDSTAR.NET
ANN POTTER RN CEM
PROJECT SPECIALIST
ER- 1 INSTITUTE
WASHINGTON HOSPITAL CENTER
ANNMPOTTER@EARTHLINK.NET

Objectives
• Discuss the process of incident action planning
• Practice completing an Incident Action Plan
• Review the Hospital Incident Command System
(HICS) tools available to assist in incident action
planning
• Develop and utilize Incident Action Plans for
hospital based response

HICS Form 214:
Operational
Log
HICS 214 – OPERATIONAL LOG
1. INCIDENT NAME 2. DATE/TIME PREPARED 3. OPERATIONAL PERIOD DATE/TIME
4. SECTION /BRANCH 5. POSITION
6. ACTIVITY LOG
Time
Major Events, Decisions Made, and Notifications Given
7. PREPARED BY (sign and print)
8. FACILITY NAME. HICS 214

:
Incident Action
Planning Process

Importance of Planning
• Maximize the available resources
• Reduce and prevent duplication of efforts
• Reduce costs
• Improve and enhance communication
• Increase effectiveness of response and recovery
actions
• Ensure understanding of the strategic direction

Incident Action Planning Process
• Core concept that takes place regardless of the
incident size or complexity
• Management by objectives will facilitate response
and recovery
• Involves 6 step process …

Step 1
1. Understanding the hospital’s policy and
direction
o
Can you care for burn patients Are you set to be a
casualty collection point What are your
decontamination capabilities Do you have alternate
care sites Can you accept forensic patients Do you
have an austere care policy What is your ability to
surge Can you provide negative isolation Can you
track exposed patients
2. Assessing the situation
3. Establishing the incident objectives
4. Determining appropriate strategies to achieve the objectives
5. Giving tactical direction and ensuring that it is followed
6. Providing necessary support

Step 2
1. Understanding the hospital’s policy and direction
2. Assessing the situation
o
How do you verify or validate information What
are your links to community partners How do
you communicate internally What are the
policies and procedures for internal hospital
assessment What relationships exist for preevent
intelligence Do you have MOUs with
response agencies Are you in the loop for
notification of threats or actual events
3. Establishing the incident objectives
4. Determining appropriate strategies to achieve the objectives
5. Giving tactical direction and ensuring that it is followed
6. Providing necessary support

Step 3
1. Understanding the hospital’s policy and direction
2. Assessing the situation
3. Establishing the incident objectives
o
o
o
Determine overall priorities based on hospital policy and
situational assessment
Set the operational period
Name the event
4. Determining appropriate strategies to achieve the objectives
5. Giving tactical direction and ensuring that it is followed
6. Providing necessary support

Step 4
1. Understanding the hospital’s policy and direction
2. Assessing the situation
3. Establishing the incident objectives
4. Determining appropriate strategies to
o
o
achieve the objectives
How to get things done: involve the response and support
partners in determining strategies to carry out the mission
Develop objectives that are Simple, Measurable,
Achievable, Realistic, Time Sensitive and Task Oriented
5. Giving tactical direction and ensuring that it is followed
6. Providing necessary support

Step 5
1. Understanding the hospital’s policy and direction
2. Assessing the situation
3. Establishing the incident objectives
4. Determining appropriate strategies to achieve the objectives
5. Giving tactical direction and ensuring that it
is followed
o
o
o
o
o
Select effective strategies and tactics
Issue assignments
Develop realistic timeframes for completion
Measure the response: continuous evaluation of actions taken
Revise tactics based on success or roadblocks
6. Providing necessary support

Step 6
1. Understanding the hospital’s policy and direction
2. Assessing the situation
3. Establishing the incident objectives
4. Determining appropriate strategies to achieve the objectives
5. Giving tactical direction and ensuring that it is followed
6. Providing necessary support
o
o
o
o
Supplies, equipment, personnel, sites
Staff, stuff, space
Project the requirements based on situational and ongoing
assessments
Ensuring command level awareness of support needs and
projections

Management by Objectives
Command and Control
› Broad organizational objectives
› Not limited to an operational period
› Do not change throughout the response and recovery phases
› Set by the Incident Commander

Objectives
Strategic Objectives
› Steps to be accomplished during the defined operational
period
› Specific objectives to achieve the command and control
objectives
› Vary across the sections
› Identify needed resources to carryout the objectives

Objectives
Tactical Objectives
› How it gets done
› Specific directions, orders, assignments to be carried out
› Evaluated for effectiveness and achievement

Major Severe Weather
Widespread Damage Across
the County
Command and Control
Strategies
Tactics

Command and Control Objective: Provide care for
inpatients, casualties and hospital staff
Operations
Section Strategic Objective Tactics
•Activate alternate care sites
for evacuated patients
•Assess facility for damage
and initiate repairs
•Activate damage teams to assess
impact on patient care areas and
designated alternate care sites
•Activate internal damage
assessment plan for all offices
and non-clinical areas to
determine use for patient care
Planning
Logistics
•Develop incident action
plan in collaboration with
Incident Commander
•Inventory and assess for
damage all supplies,
equipment, food and
water resources
•Gather situational
information from community
partners
•Notify all sections to provide
staffing names
•Notify department heads to
inventory all designated
emergency supplies and
equipment and report
damages and shortages

Identify Resources and Assignments
• Activate Hospital Command Center (HCC) positions
needed for the response
• Identify needed personnel trained to fill HCC roles
• Assign staff for incident specific response
◦ Triage
◦ Structural assessment
◦ Evacuation

Ongoing Evaluation and Revision
• Was the strategy effective
• Are the tactics safe Are staff, patients or
community responders at risk when they carry out
the tactics
• Are staff stressed Are there sufficient numbers
• Are additional strategies and tactics needed to meet
the command objective

Documentation
IAP must be in writing
› Provides a common set of objectives
› Provides a framework for response
› Enhances communication among HCC staff
› Enhances communication with response partners
› Provides a tool for evaluation of the response; archive of
actions taken and effectiveness of the response (After Action
Report/Improvement Plan)
› Risk management tool: “if it wasn’t written down…”

Implement Corrective Actions
Corrective action planning is an ongoing process
If it isn't working, identify the problem and develop
new strategies
Assess impact of actions taken on the hospital: is it
positive or negative
Use the Incident Action Planning process to
evaluate the response, identify new strategies and
resources and correct the process

:
Using the HICS Tools:
Incident Response
Guides

Incident Response Guides
Specific objectives, strategies and tactics for the
identified event
Activated during the response
Provide critical considerations and actions steps for
Command and General staff
Time based
› Immediate 0-2 hrs
› Intermediate 2-12 hrs
› Extended ≥ 12 hours and beyond
› Demobilization and System Recovery

Incident Response Guides
• Identify initial actions
• Serve as a documentation tool
• Identifies actions for Command and General staff as
well as section specific
• Facilitates incident action planning

External IRG: Severe weather
Mission: To maintain hospital operations for a minimum of 72
hours following a major earthquake that may impact the structural
integrity of the facility, and to ensure the continuum of care for
patients, visitors, and casualties of the event.
Directions
Read this entire response guide and review organization chart.
Use this response guide as a checklist to ensure all tasks are
addressed and completed.
Objectives
Damage Assessment
Patients, visitors, staff assessed for injuries and accounted for
Patient tracking
Hospital facility self-sustainment for a minimum of 72 hours

Immediate Actions (Operational Period 0-2 Hours)
COMMAND
Incident Commander:
Activate the facility Emergency Operations Plan
Appoint Planning, Operations and Logistics Section Chiefs
Appoint Medical Technical Specialists – Hospital Administration,
Clinic Administration and Risk Management, as appropriate
Liaison Officer:
Communicate with local Emergency Operations Center and officials
to determine extent of damage to critical infrastructure and services
Communicate with other hospitals to determine status
Coordinate and communicate with (regional) HCC or equivalent;
notify as appropriate
Public Information Officer:
Obtain information from Situation Unit Leader to provide situation
briefing to hospital patients, visitors, and staff

Immediate Actions (Operational Period 0-2
Hours)
OPERATIONS
Activate alternate care sites for evacuated patients
Implement evacuation of unsafe/unstable areas of the facility
Assess facility for damage, initiate repairs as appropriate or
secure unsafe areas
Activate search procedures as appropriate
Assess status of security systems, access and egress from
facility, and implement security plan
Prepare to receive incident casualties; establish triage and
treatment areas, discharge areas and appropriate protocols
Conduct an census of inpatients, clinic patients, those
available for discharge
Ensure continued functioning of emergency power
generators
Consider activating HazMat Branch if any facility damage
resulting in hazardous materials spill or incident

Immediate Actions (Operational Period 0-2 Hours)
PLANNING
Initiate patient, bed, materiel and personnel tracking
procedures
Establish operational periods and develop Incident Action
Plan in collaboration with the Incident Commander
LOGISTICS
Inventory and assess for damage all supplies, equipment,
food and water stores
Activate alternate communication systems and establish
contact with local EOC, EMS and ensure intra-hospital
communications with walkie talkies, runners, etc.
Project needs for 72 hours and institute rationing, if
appropriate.

Other Points About Incident
Response Guide
• IRG continues through demobilization and system
recovery phases (expanded concept within HICS
guidance)
• Identifies actions for return to normal operations
• Enhances after action review and corrective
improvement: closing the loop

Demobilization/System Recovery
PLANNING
Prepare a summary of response operations, including number of patients
received, status and current census
Write an after-action report including these topics:
Summary of the incident
Response activities that went well
Response activities that need improvement
Recommendations for future actions
LOGISTICS
Restock supplies, equipment and medications to normal levels
Compile a final facility damage and repair report
Conduct stress manage services and debriefings for staff, as appropriate
FINANCE
Prepare a final summary of response costs and expenditures for approval by the
Incident Commander
Submit claims to insurance companies, as appropriate
Submit patient records and other appropriate information for reimbursement

IRG planning tool:
HCC staffing
Public
Information
Officer
Incident Commander
Safety
Officer
Immediate
Phase 0-2 hrs
Operations
Section Chief
Liaison
Officer
Planning
Section Chief
Medical/
Technical
Specialist
Logistics
Section Chief
Biological/Infectious Disease
Chemical
Radiological
Clinic Administration
Hospital Administration
Legal Affairs
Risk Management
Medical Staff
Pediatric Care
Medical Ethicist
Finance/
Administration
Section Chief
Staging
Manager
Personnel
Vehicle
Equipment/Supply
Medication
Resources
Unit Leader
Personnel Tracking
Materiel Tracking
Service
Branch Director
Communications Unit
IT/IS Unit
Staff Food & Water Unit
Time
Unit Leader
Medical Care
Branch Director
Inpatient Unit
Outpatient Unit
Casualty Care Unit
Mental Health Unit
Clinical Support Services Unit
Patient Registration Unit
Situation
Unit Leader
Patient Tracking
Bed Tracking
Support
Branch
Director
Employee Health & Well-Being Unit
Family Care Unit
Supply Unit
Facilities Unit
Transportation Unit
Labor Pool & Credentialing Unit
Procurement
Unit Leader
Infrastructure
Branch Director
Power/Lighting Unit
Water/Sewer Unit
HVAC Unit
Building/Grounds Damage Unit
Medical Gases Unit
Medical Devices Unit
Environmental Services Unit
Food Services Unit
Documentation
Unit Leader
Compensation/
Claims
Unit Leader
HazMat
Branch Director
Detection and Monitoring Unit
Spill Response Unit
Victim Decontamination Unit
Facility/Equipment
Decontamination Unit
Demobilization
Unit Leader
Cost
Unit Leader
Security
Branch Director
Access Control Unit
Crowd Control Unit
Traffic Control Unit
Search Unit
Law Enforcement Interface Unit
Business
Continuity
Branch Director
Information Technology Unit
Service Continuity Unit
Records Preservation Unit
Business Function Relocation Unit
Legend
Activated Position

IRG planning tool:
HCC staffing
Public
Information
Officer
Incident Commander
Safety
Officer
Demobilization /
System Recovery
Operations
Section Chief
Liaison
Officer
Planning
Section Chief
Medical/
Technical
Specialist
Logistics
Section Chief
Biological/Infectious Disease
Chemical
Radiological
Clinic Administration
Hospital Administration
Legal Affairs
Risk Management
Medical Staff
Pediatric Care
Medical Ethicist
Finance/
Administration
Section Chief
Staging
Manager
Personnel
Vehicle
Equipment/Supply
Medication
Resources
Unit Leader
Personnel Tracking
Materiel Tracking
Service
Branch Director
Communications Unit
IT/IS Unit
Staff Food & Water Unit
Time
Unit Leader
Medical Care
Branch Director
Inpatient Unit
Outpatient Unit
Casualty Care Unit
Mental Health Unit
Clinical Support Services Unit
Patient Registration Unit
Situation
Unit Leader
Patient Tracking
Bed Tracking
Support
Branch
Director
Employee Health & Well-Being Unit
Family Care Unit
Supply Unit
Facilities Unit
Transportation Unit
Labor Pool & Credentialing Unit
Procurement
Unit Leader
Infrastructure
Branch Director
Power/Lighting Unit
Water/Sewer Unit
HVAC Unit
Building/Grounds Damage Unit
Medical Gases Unit
Medical Devices Unit
Environmental Services Unit
Food Services Unit
Documentation
Unit Leader
Compensation/
Claims
Unit Leader
HazMat
Branch Director
Detection and Monitoring Unit
Spill Response Unit
Victim Decontamination Unit
Facility/Equipment
Decontamination Unit
Demobilization
Unit Leader
Cost
Unit Leader
Security
Branch Director
Access Control Unit
Crowd Control Unit
Traffic Control Unit
Search Unit
Law Enforcement Interface Unit
Business
Continuity
Branch Director
Information Technology Unit
Service Continuity Unit
Records Preservation Unit
Business Function Relocation Unit
Legend
Activated Position

Incident Response Guides
• Kick start the response
• Initiate Incident Action Planning
• Provide recommendations for objectives and
Hospital Command Center staffing throughout the
response and recovery phases

Using the HICS Tools:
IAP Forms

HICS Forms
• FEMA forms used by emergency responders in the
field and at the Emergency Operations Center
• Forms reviewed and customized for hospital use
• Standardizes the hospital documentation and
communication procedures
• Facilitates response and communication with
partners, coordinating entities and governing bodies

HICS IAP Forms
• 20 forms developed
• Facility specific forms can be added to augment the
Incident Action Plan and response and recovery
phases
• Standardized format
• May be customized to your facility or healthcare
system
• May be completed electronically or in hard copy

What They Have in Common
• Form name and number
• Purpose
• Origination
• Copies (distribution)
• When to complete
• Helpful tips
• Instructions for use
• Facility customization

HICS Forms
No. Name Responsible
201 Incident Briefing Incident Commander
202 Incident Objectives Section Chiefs
203 Organizational Assignment List Resource Unit Leader
204 Branch Assignment List Branch Directors
205 Communications Log Communications Unit Leader
206 Staff Medical Plan Support Branch Director
207 Organization Chart Incident Commander
213 Incident Message Form All Positions
214 Operational Log Command Staff and General
Staff
251 Facility System Status Report Infrastructure Branch
Director

HICS Forms
No. Name Responsible
252 Section Personnel Time Sheet Section Chiefs
253 Volunteer Staff Registration Labor Pool & Credentailing Unit
Leader
254 Disaster Victim / Pt Tracking Form Patient Tracking Manager
255 Master Pt Evacuation Tracking Form Patient Tracking Manager
256 Procurement Summary Report Procurement Unit Leader
257 Resource Accounting Record Section Chiefs
258 Hospital Resource Directory Resource Unit Leader
259 Hospital Casualty / Fatality Report Patient Tracking Manager
260 Patient Evacuation Tracking Form Inpt Unit Leader Outpt Unit
Leader, Casualty Care Unit Leader
261 Incident Action Plan Safety Analysis Safety Officer

HICS Form 201
Purpose: Document initial response information
and actions taken at start-up
› Information received
› HCC activation, positions in IMT, outside contacts made,
special considerations…
Origination: Incident Commander
› Or designee
Copies to: Command staff, Section Chiefs,
Documentation Unit Leader
› Customize the distribution

Complete the 201
• Incident Name: who names the incident
• Operational Period: who determines What factors
should be considered
• Date: yr/month/day
• Time: 24 hour clock

Purpose: Document Initial response information and actions taken at
startup
Origination: Incident Commander
Copies to: Command Staff, Section Chiefs and Documentation Unit
Leader
HICS 201
Page 2 of 2

What Other Forms Should be Initially Completed
• 202 Incident Objectives
• 203 Organization Assignment List
• 204 Branch Assignment List
• 205 Incident Communications Plan
• 206 Staff Medical Plan
• 207 Organization Chart
• 213 Incident Message Form
• 214 Operational Log
• 251 Facility System Status Report

Incident Action Plan
Let’s review…
• What forms make up the Incident Action Plan
• Can additional forms be added
• Can hospital specific forms be included

• 252 Section Personnel Time Sheet
• 253 Volunteer Staff Registration
• 254 Disaster Victim / Pt Tracking Form
• 255 Master Pt Evacuation Tracking Form
• 256 Procurement Summary Report
• 257 Resource Accounting Record
• 258 Hospital Resource Directory
• 259 Hospital Casualty / Fatality Report
• 260 Patient Evacuation Tracking Form
• 261 Incident Action Plan Safety Analysis

Exercise the Lessons
Learned

Exercise #1: Internal Event
Today is a Saturday on a three day holiday weekend.
There is a fire in several transponders in the main
power plant in the city; power fails in a 30 mile area.
Power officials project that the power may not be
restored for three days.
Your hospital has lost all external power and
emergency generators are supplying emergency power
to the facility. The hospital census is at 85% capacity.

What Now
• Is an IAP indicated Why
• Is this a self limiting event

What Else
• What do we know; what have we done
• Who do we need in the Incident Management Team
• What are our objectives

Its Getting Worse
• The hospital’s third floor (82 beds) must be
evacuated due to lack of power.
• The outpatient pharmacy must close; the computers
are down and prescriptions cannot be entered or
verified.
• Media arrive at the hospital asking about patient
safety.

Who is the Team and
What are They Doing
• What actions can / should be taken
• What IMT Positions are needed
• Group Activity: Complete the IAP

Utilize the Incident Action Plan
• Take an Incident Management Team role and use
the IAP
• Does it provide direction
• What else do you need to do

Its Coming Up on Shift Change
• What actions can / should be taken
• Who fills out the next IAP
• What should it include

Summary
• You won’t succeed without a battle plan ….IAP
• Consists of objectives , strategies and tactics in a
standardized format
• Completed for each operational period
• Used by each IMT member to assist in getting their
job done effectively and collaboratively
• Used to evaluate the response and improve the
emergency management program

Hospital Incident Command System
The Evolution Continues
2011 Integrated Medical, Public Health and Preparedness
and Response Training Summit
Craig DeAtley PA-C
Director, IPHER
Washington Hospital Center
Co-Executive Director
Center for HICS Education and Training
Ph 202-257-4714
craig.deatley@medstar.net
Ann Potter RN CEM
Project Specialist
ER-1 Institute
Washington Hospital Center
annmpotter@earthlink.net

Introduction
• Who are we
• What do we know about the Hospital
Incident Command System
• What are we trying to do today

HICS Today
• Revision project completed in 2006
• National workgroup, secondary review group, Ex Officio members
• Center for HICS Education and Training
• Focus on HICS education and review of materials
• Board composed of original HICS Workgroup members
• Provide courses in implementation and application of HICS
concepts
• Review, revision and update is in planning
stage

HICS Use Today
• 2009 HICS Revision Survey via Survey Monkey
• Designed and conducted to provide needed
incite on the use of HICS concepts and materials
• Notice sent out inviting participation
• Nearly 900 respondents

Survey Results
• Participant Demographics
• 95% of participants work in a hospital
setting
• 59.2% of participants work as an
Emergency Program Manager

Hospital Demographic Data

Use of ICS in the Hospital
• Does your facility utilize the HICS
• HEICS: 10.5%
• HICS: 89.5%
• If you do not utilize HICS, is there
another ICS format used
• FireScope: 6.3%
• FEMA ICS: 93.8%

The Guidebook
• 80.3% use the HICS Guidebook in the development of
the emergency operations plan or its appendices
• Recommended revisions to the Guidebook
• Increase the guidance on applicability and
customization of the materials
• Increase the focus on incident action planning
• Too many forms, organizational charts are too large
• Too cumbersome for smaller hospital
Take away points
• Increase educational materials
• Expand section on incident action planning

Scenarios
• 62.5% of
respondents use
the scenarios to
develop exercises

Recommended Scenarios
for Development
• Tornado
• Communications failure
• Wildland fire
• Active Shooter
• External flooding

Use of the Incident Planning
and Response Guides
• 57.2 % of respondents use one or more
IPGs for development of hazard specific
response
• 46.8% of respondents use one or more
IRGs in the emergency response plan
• Use in actual events included power failure,
earthquake, fire, HVAC disruption
Recommended development of additional
guides mirrors scenario recommendations

Organizational Chart to Incident
Management Team Chart
• 73.9% utilize the revised IMT chart
• 71.8% of respondents found it easy to adapt
Org Chart to IMT Chart
• Utilization of Guidebook to make the adaptation
• 86.8% acknowledged the consistency of the
IMT Chart to NIMS approach
Recommendation to provide more guidance
on use of the IMT at all hospitals

Job Action Sheets
• 92.9% of respondents utilize the JAS,
with 83.7% using the revised forms
• 55.5% of respondents recommend
revisions
Clarity
Content
More concise

HICS Forms
• Ease in use of forms and instructions
• Customized to the facility
• Have provided training to staff
Need more education on how, when and which
forms to use
Improve training on incident action planning
concepts and form use
How to secure leadership support on using forms

Center for HICS Education
and Training website
• Revision in progress
• Increase use as an emergency
management program development tool
• Site for sharing of promising practices
• Updates on national and international
practices in emergency response and
current events

General
Recommendations
• Increase “how-to” section
• Develop guidance on exercise planning
and execution
• Condensation of materials
• Address the visual magnitude: how to
scale down and back for your facility
• Take away point: education

Summary
• HICS continues to be applied in health
care settings with adaptations: large
and small hospitals, clinics, long term
care
• Recommended changes are being
evaluated and acted upon

HICS 201 – INCIDENT BRIEFING
PURPOSE: DOCUMENT INITIAL RESPONSE INFORMATION AND ACTIONS TAKEN AT STARTUP.
ORIGINATION: INCIDENT COMMANDER.
COPIES TO: COMMAND STAFF, SECTION CHIEFS, AND DOCUMENTATION UNIT LEADER.
INSTRUCTIONS:
Print legibly, and enter complete information.
(Page 1 of 2)
1. INCIDENT NAME If the incident is internal to the hospital, the name may be given by the hospital’s Incident
Commander. If the incident affects the larger community, the name may be given by a local authority (e.g.,
fire department, local EOC, etc.).
2. DATE OF BRIEFING Use the international standard date notation YYYY-MM-DD, where YYYY is the year,
MM is the month of the year between 01 (January) and 12 (December), and DD is the day of the month
between 01 and 31. For example, the fourteenth day of February in the year 2006 is written as 2006-02-14.
3. TIME OF BRIEFING Use the international standard notation hh:mm, where hh is the number of complete
hours that have passed since midnight (00-24), and mm is the number of complete minutes that have passed
since the start of the hour (00-59). For example, 5:04 PM is written as 17:04. Use local time.
4. EVENT HISTORY AND CURRENT ACTIONS SUMMARY Document input from Section Chiefs and affected
leadership and/or organizations involved.
5. CURRENT ORGANIZATION Use proper names to identify personnel who are performing incident
management functions as part of the HICS organization structure.
(Page 2 of 2)
6. NOTES (INCLUDING ACCOMPLISHMENTS, ISSUES, WARNINGS/DIRECTIVES) Self-explanatory. Use
blank space for maps and other diagrams.
7. PREPARED BY (NAME AND POSITION) Use proper name and HICS position title.
8. FACILITY NAME Use when transmitting the form outside of the hospital.
WHEN TO COMPLETE: Prior to briefing in the current operational period.
HELPFUL TIPS: Distribute copies to all staff before initial briefing.

INCIDENT BRIEFING
1. INCIDENT NAME 2. DATE OF BRIEFING 3. TIME OF BRIEFING
4. EVENT HISTORY AND CURRENT ACTIONS SUMMARY
5. CURRENT ORGANIZATION
INCIDENT COMMANDER
PUBLIC INFORMATION OFFICER
SAFETY OFFICER
LIAISON OFFICER
MEDICAL/TECHNICAL SPECIALIST(S)
OPERATIONS SECTION CHIEF PLANNING SECTION CHIEF LOGISTICS SECTION CHIEF FINANCE/ADMINISTRATION
SECTION CHIEF
BRANCH DIRECTOR/UNIT LEADER
STAGING MANAGER/TEAM LEADER
BRANCH DIRECTOR/UNIT LEADER
BRANCH DIRECTOR/UNIT LEADER
BRANCH DIRECTOR/UNIT LEADER
BRANCH DIRECTOR/UNIT LEADER
BRANCH DIRECTOR/UNIT LEADER
BRANCH DIRECTOR/UNIT LEADER
PURPOSE: DOCUMENT INITIAL RESPONSE INFORMATION AND ACTIONS TAKEN AT STARTUP. ORIGINATION: INCIDENT COMMANDER. HICS 201
COPIES TO: COMMAND STAFF, SECTION CHIEFS, AND DOCUMENTATION UNIT LEADER. PAGE 1 OF 2

INCIDENT BRIEFING
6. NOTES (INCLUDING ACCOMPLISHMENTS, ISSUES, WARNINGS/DIRECTIVES)
7. PREPARED BY (NAME AND POSITION) 8. FACILITY NAME
PURPOSE: DOCUMENT INITIAL RESPONSE INFORMATION AND ACTIONS TAKEN AT STARTUP. ORIGINATION: INCIDENT COMMANDER. HICS 201
COPIES TO: COMMAND STAFF, SECTION CHIEFS, AND DOCUMENTATION UNIT LEADER. PAGE 2 OF 2

HICS 202 – INCIDENT OBJECTIVES
PURPOSE: DEFINE OBJECTIVES AND ISSUES FOR OPERATIONAL PERIOD.
ORIGINATION: PLANNING SECTION CHIEF.
COPIES TO: COMMAND STAFF, GENERAL STAFF, AND DOCUMENTATION UNIT LEADER.
INSTRUCTIONS:
Print legibly, and enter complete information.
1. INCIDENT NAME If the incident is internal to the hospital, the name may be given by the hospital’s Incident
Commander. If the incident affects the larger community, the name may be given by a local authority (e.g.,
fire department, local EOC, etc.).
2. DATE PREPARED Use the international standard date notation YYYY-MM-DD, where YYYY is the year, MM
is the month of the year between 01 (January) and 12 (December), and DD is the day of the month between
01 and 31. For example, the fourteenth day of February in the year 2006 is written as 2006-02-14.
3. TIME PREPARED Use the international standard notation hh:mm, where hh is the number of complete
hours that have passed since midnight (00-24), and mm is the number of complete minutes that have passed
since the start of the hour (00-59). For example, 5:04 PM is written as 17:04. Use local time.
4. OPERATIONAL PERIOD DATE/TIME Identify the operational period during which this information applies.
This is the time period established by the hospital’s Incident Commander, during which current objectives are
to be accomplished and at the end of which they are evaluated. For example, a 12-hour operational period
might be 2006-08-16 18:00 to 2006-08-17 06:00.
5. GENERAL COMMAND AND CONTROL OBJECTIVES FOR THE INCIDENT (INCLUDE ALTERNATIVES)
Use input from Section Chiefs and from affected leadership and/or organizations involved. Key questions to
consider include: What is the problem What are the obstacles What resources are needed to address the
objectives What are considerations for the next operational period
6. WEATHER / ENVIRONMENTAL IMPLICATIONS FOR PERIOD (INCLUDE AS APPROPRIATE:
FORECAST, WIND SPEED/DIRECTION, DAYLIGHT) Document weather and environmental factors that
could affect operations.
7. GENERAL SAFETY / STAFF MESSAGES TO BE GIVEN Summarize decisions made during Command
meetings to convey to staff. Refer to HICS 261, Incident Action Plan Safety Analysis, to identify safety
messages.
8. ATTACHMENTS (MARK IF ATTACHED) Check boxes that correspond with the attachments to this form.
9. PREPARED BY (PLANNING SECTION CHIEF) Use proper name.
10. APPROVED BY (INCIDENT COMMANDER) The signature of the Incident Commander indicates approval of
the objectives.
11. FACILITY NAME Use when transmitting the form outside of the hospital.
WHEN TO COMPLETE: Prior to briefing in the current operational period.
HELPFUL TIPS: This document serves as a roadmap to incident management. Use this form during the initial
operational period, and use updated versions prior to the beginning of subsequent operational periods. Refer to
this form during briefings and debriefings.

INCIDENT OBJECTIVES
1. INCIDENT NAME
2. DATE PREPARED 3. TIME PREPARED 4. OPERATIONAL PERIOD DATE/TIME
5. GENERAL COMMAND AND CONTROL OBJECTIVES FOR THE INCIDENT (INCLUDE ALTERNATIVES)
6. WEATHER / ENVIRONMENTAL IMPLICATIONS FOR PERIOD (INCLUDE AS APPROPRIATE: FORECAST, WIND SPEED/DIRECTION, DAYLIGHT)
7. GENERAL SAFETY / STAFF MESSAGES TO BE GIVEN
Examples: Personal Protective Equipment (PPE), Precautions, Case Definitions (refer to HICS 261 Incident Action Plan Safety Analysis)
8. ATTACHMENTS (MARK IF ATTACHED)
HICS 203 - Organization Assignment List HICS 206 - Medical Plan Traffic Plan
HICS 204 - Branch Assignment List HICS 251 - Facility System Status Report Incident Map
HICS 205 - Incident Communications Plan HICS 261 - Incident Action Plan Safety Analysis Other
9. PREPARED BY (PLANNING SECTION CHIEF) 10. APPROVED BY (INCIDENT COMMANDER)
11. FACILITY NAME
PURPOSE: DEFINE OBJECTIVES AND ISSUES FOR OPERATIONAL PERIOD. ORIGINATION: PLANNING SECTION CHIEF.
COPIES TO: COMMAND STAFF, GENERAL STAFF, AND DOCUMENTATION UNIT LEADER. HICS 202

HICS 203 – ORGANIZATION ASSIGNMENT LIST
PURPOSE: DOCUMENT STAFFING.
ORIGINATION: RESOURCES UNIT LEADER.
COPIES TO: COMMAND STAFF, GENERAL STAFF, AGENCY STAFF, BRANCH DIRECTORS, AND
DOCUMENTATION UNIT LEADER.
INSTRUCTIONS:
Print legibly, and enter complete information.
1. INCIDENT NAME If the incident is internal to the hospital, the name may be given by the hospital’s Incident
Commander. If the incident affects the larger community, the name may be given by a local authority (e.g.,
fire department, local EOC, etc.).
2. DATE PREPARED Use the international standard date notation YYYY-MM-DD, where YYYY is the year, MM
is the month of the year between 01 (January) and 12 (December), and DD is the day of the month between
01 and 31. For example, the fourteenth day of February in the year 2006 is written as 2006-02-14.
3. TIME PREPARED Use the international standard notation hh:mm, where hh is the number of complete
hours that have passed since midnight (00-24), and mm is the number of complete minutes that have passed
since the start of the hour (00-59). For example, 5:04 PM is written as 17:04. Use local time.
4. OPERATIONAL PERIOD DATE/TIME Identify the operational period during which this information applies.
This is the time period established by the hospital’s Incident Commander, during which current objectives are
to be accomplished and at the end of which they are evaluated. For example, a 12-hour operational period
might be 2006-08-16 18:00 to 2006-08-17 06:00.
5. INCIDENT COMMANDER AND STAFF Use proper names to identify personnel assigned to positions, and
include agency name if personnel is external.
6. OPERATIONS SECTION Use proper names to identify personnel assigned to positions, and include agency
name if personnel is external.
7. PLANNING SECTION Use proper names to identify personnel assigned to positions, and include agency
name if personnel is external.
8. LOGISTICS SECTION Use proper names to identify personnel assigned to positions, and include agency
name if personnel is external.
9. FINANCE/ADMINISTRATION SECTION Use proper names to identify personnel assigned to positions, and
include agency name if personnel is external.
10. AGENCY REPRESENTATIVE (IN HOSPITAL COMMAND CENTER) Use proper name to identify personnel
representing external agency, and include agency name.
11. HOSPITAL REPRESENTATIVE (IN EXTERNAL EOC) Use proper name to identify hospital personnel
assigned to an external EOC, and identify location of external EOC.
12. PREPARED BY (RESOURCES UNIT LEADER) Use proper name.
13. FACILITY NAME Use when transmitting the form outside of the hospital.
WHEN TO COMPLETE: At the start of the first operational period, prior to each subsequent operational period,
and as additional positions are staffed.
HELPFUL TIPS: Use this form as a reminder of positions to consider when organizing personnel to manage an
incident, as indicated by the situation. Retain this form for reference during the incident. Cross-reference
information on this form and on HICS 201, Incident Briefing. Post this form in the Hospital Command Center, and
make copies available to Branch Directors. Share copies with other agencies (e.g., the local EOC, other hospitals
in the area or healthcare system, etc.), as appropriate.

ORGANIZATION ASSIGNMENT LIST
1. INCIDENT NAME
2. DATE PREPARED 3. TIME PREPARED 4. OPERATIONAL PERIOD DATE/TIME
POSITION
5. INCIDENT COMMANDER AND STAFF
NAME/AGENCY
Incident Commander
Public Information Officer
Liaison Officer
Safety Officer
Medical/Technical Specialist (Type)
Medical/Technical Specialist (Type)
Medical/Technical Specialist (Type)
Medical/Technical Specialist (Type)
Medical/Technical Specialist (Type)
Medical/Technical Specialist (Type)
6. OPERATIONS SECTION
Chief
Staging Manager
Medical Care Branch
Infrastructure Branch
HazMat Branch
Security Branch
Business Continuity Branch
(Other) Branch:
7. PLANNING SECTION
Chief
Resources Unit
Situation Unit
Documentation Unit
Demobilization Unit
8. LOGISTICS SECTION
Chief
Service Branch
Support Branch
9. FINANCE/ADMINISTRATION SECTION
Chief
Time Unit
Procurement Unit
Compensation/Claims Unit
Cost Unit
10. AGENCY REPRESENTATIVE (IN HOSPITAL COMMAND CENTER)
11. HOSPITAL REPRESENTATIVE (IN EXTERNAL EOC)
Name
External Location
12. PREPARED BY (RESOURCES UNIT LEADER) 13. FACILITY NAME
PURPOSE: DOCUMENT STAFFING. ORIGINATION: RESOURCES UNIT LEADER.
COPIES TO: COMMAND STAFF, GENERAL STAFF, AGENCY STAFF, BRANCH DIRECTORS AND DOCUMENTATION UNIT LEADER. HICS 203

HICS 204 – BRANCH ASSIGNMENT LIST
PURPOSE: DOCUMENT ASSIGNMENTS WITHIN BRANCH.
ORIGINATION: BRANCH DIRECTOR.
COPIES TO: COMMAND STAFF, GENERAL STAFF, AND DOCUMENTATION UNIT LEADER.
INSTRUCTIONS:
Print legibly, and enter complete information.
1. INCIDENT NAME If the incident is internal to the hospital, the name may be given by the hospital’s Incident
Commander. If the incident affects the larger community, the name may be given by a local authority (e.g.,
fire department, local EOC, etc.).
2. SECTION Indicate the Section for which this assignment list is being prepared.
3. BRANCH Indicate the Branch for which this assignment list is being prepared.
4. OPERATIONAL PERIOD DATE/TIME Identify the operational period during which this information applies.
This is the time period established by the hospital’s Incident Commander, during which current objectives are
to be accomplished and at the end of which they are evaluated. For example, a 12-hour operational period
might be 2006-08-16 18:00 to 2006-08-17 06:00.
5. PERSONNEL Use proper names to identify Section Chief and Branch Director.
6. UNITS ASSIGNED THIS PERIOD For each Unit assigned: identify the Unit Name (e.g., Spill Response
Unit), use proper name to identify the Unit Leader, identify the Unit’s Location, list the Unit’s specific
Objectives, and use proper names to list the Members assigned to the Unit.
7. KEY OBJECTIVES Summarize the fundamental objectives assigned to this Branch for the current
operational period.
8. SPECIAL INFORMATION / CONSIDERATION Identify special instructions to convey to personnel on safety,
communications, and considerations for the operational period.
9. PREPARED BY (BRANCH DIRECTOR) Use proper name.
10. APPROVED BY (PLANNING SECTION CHIEF) The signature of the Planning Section Chief indicates
approval of the assignments.
11. DATE Use the international standard date notation YYYY-MM-DD, where YYYY is the year, MM is the month
of the year between 01 (January) and 12 (December), and DD is the day of the month between 01 and 31.
For example, the fourteenth day of February in the year 2006 is written as 2006-02-14.
12. TIME Use the international standard notation hh:mm, where hh is the number of complete hours that have
passed since midnight (00-24), and mm is the number of complete minutes that have passed since the start
of the hour (00-59). For example, 5:04 PM is written as 17:04. Use local time.
13. FACILITY NAME Use when transmitting the form outside of the hospital.
WHEN TO COMPLETE: At the start of each operational period.
HELPFUL TIPS: Use this form to identify Units assigned within a Branch, personnel assigned to lead and staff
each Unit, and details of their location and assigned objective. Summarize Branch objectives and special
information for reference.

BRANCH ASSIGNMENT LIST
1. INCIDENT NAME
2. SECTION 3. BRANCH 4. OPERATIONAL PERIOD DATE/TIME
5. PERSONNEL
Section Chief
Branch Director
6. UNITS ASSIGNED THIS PERIOD
Name Name Name Name Name Name
Leader Leader Leader Leader Leader Leader
Location Location Location Location Location Location
Objective Objective Objective Objective Objective Objective
Members Members Members Members Members Members
7. KEY OBJECTIVES
8. SPECIAL INFORMATION / CONSIDERATION
9. PREPARED BY (BRANCH DIRECTOR) 10. APPROVED BY (PLANNING SECTION CHIEF) 11. DATE 12. TIME
13. FACILITY NAME
PURPOSE: DOCUMENT ASSIGNMENTS WITHIN BRANCH. ORIGINATION: BRANCH DIRECTOR. HICS 204
COPIES TO: COMMAND STAFF, GENERAL STAFF, AND DOCUMENTATION UNIT LEADER.
PAGE ___ OF ___

HICS 207 – ORGANIZATION CHART
PURPOSE: DOCUMENT HICS POSITIONS ASSIGNED.
ORIGINATION: INCIDENT COMMANDER.
COPIES TO: COMMAND STAFF, GENERAL STAFF, BRANCH DIRECTORS, UNIT LEADERS, AND
DOCUMENTATION UNIT LEADER.
INSTRUCTIONS:
Print legibly, and enter complete information.
1. INCIDENT NAME If the incident is internal to the hospital, the name may be given by the hospital’s Incident
Commander. If the incident affects the larger community, the name may be given by a local authority (e.g.,
fire department, local EOC, etc.).
2. DATE PREPARED Use the international standard date notation YYYY-MM-DD, where YYYY is the year, MM
is the month of the year between 01 (January) and 12 (December), and DD is the day of the month between
01 and 31. For example, the fourteenth day of February in the year 2006 is written as 2006-02-14.
3. TIME PREPARED Use the international standard notation hh:mm, where hh is the number of complete
hours that have passed since midnight (00-24), and mm is the number of complete minutes that have passed
since the start of the hour (00-59). For example, 5:04 PM is written as 17:04. Use local time.
4. OPERATIONAL PERIOD DATE/TIME Identify the operational period during which this information applies.
This is the time period established by the hospital’s Incident Commander, during which current objectives are
to be accomplished and at the end of which they are evaluated. For example, a 12-hour operational period
might be 2006-08-16 18:00 to 2006-08-17 06:00.
5. ORGANIZATION CHART Use proper names to identify personnel assigned to positions. Refer to
information recorded in HICS 203, Organization Assignment List, as available.
6. FACILITY NAME Use when transmitting the form outside of the hospital.
WHEN TO COMPLETE: Whenever possible prior to an event, at the start of each operational period, and as
changes are made.
HELPFUL TIPS: This form identifies personnel with predefined responsibilities, establishing ideal reporting and
communication lines. Display this form prominently in a central location within the Hospital Command Center.

ORGANIZATION CHART
1. INCIDENT NAME 2.DATE PREPARED 3. TIME PREPARED 4. OPERATIONAL PERIOD DATE/TIME
5. ORGANIZATIONAL CHART
INCIDENT COMMANDER
PUBLIC INFORMATION OFFICER
LIAISON OFFICER
SAFETY OFFICER
MEDICAL/TECHNICAL SPECIALIST(S)
Biological/Infectious Disease
Chemical
Radiological
Clinic Administration
Hospital Administration
Legal Affairs
Risk Management
Medical Staff
Pediatric Care
Medical Ethicist
OPERATIONS SECTION CHIEF PLANNING SECTION CHIEF LOGISTICS SECTION CHIEF FINANCE/ADMINISTRATION
SECTION CHIEF
STAGING MANAGER
RESOURCE UNIT LEADER
SERVICE BRANCH DIRECTOR
TIME UNIT LEADER
Personnel Staging Team
Vehicle Staging Team
Equipment/Supply Staging Team
Medication Staging Team
MEDICAL CARE BRANCH
DIRECTOR
Inpatient Unit
Outpatient Unit
Casualty Care Unit
Clinical Support Services Unit
Mental Health Unit
Patient Registration Unit
INFRASTRUCTURE BRANCH
DIRECTOR
Personnal Tracking
Material Tracking
SITUATION UNIT LEADER
Patient Tracking
Bed Tracking
DOCUMENTATION UNIT
LEADER
DEMOBILIZATION UNIT
LEADER
Communications Unit
IT/IS Unit
Staff Food & Water Unit
SUPPORT BRANCH DIRECTOR
Employee Health & Well-Being Unit
Family Care Unit
Supply Unit
Facilities Unit
Transportation Unit
Labor Pool & Credentialing Unit
PROCUREMENT UNIT LEADER
COMPENSATION/CLAIMS
UNIT LEADER
COST UNIT LEADER
Power/Lighting Unit
Water/Sewer Unit
HVAC Unit
Building/Grounds Damage Unit
Medical Gases Unit
Medical Devices Unit
Environmental Services Unit
Food Services Unit
HAZMAT BRANCH DIRECTOR
Detection and Monitoring Unit
Spill Response Unit
Victim Decontamination Unit
Facility/Equipment Decontamination Unit
SECURITY BRANCH DIRECTOR
Access Control Unit
Crowd Control Unit
Traffic Control Unit
Search Unit
Law Enforcement Interface Unit
BUSINESS CONTINUITY
BRANCH DIRECTOR
Information Technology Unit
Service Continuity Unit
Records Preservation Unit
Business Function Relocation Unit
6. FACILITY NAME
PURPOSE: DOCUMENT HICS POSITIONS ASSIGNED. ORIGINATION: INCIDENT COMMANDER.
COPIES TO: COMMAND STAFF, GENERAL STAFF, BRANCH DIRECTORS, UNIT LEADERS, AND DOCUMENTATION UNIT LEADER. HICS 207

HICS 213 – INCIDENT MESSAGE FORM
PURPOSE: PROVIDE STANDARDIZED METHOD FOR RECORDING MESSAGES RECEIVED BY PHONE OR
RADIO.
ORIGINATION: ALL POSITIONS.
ORIGINAL TO: RECEIVER.
COPIES TO: DOCUMENTATION UNIT LEADER AND MESSAGE TAKER.
INSTRUCTIONS:
Print legibly, and enter complete information.
1. FROM (SENDER) Use proper name to identify who is sending the message. Include title and agency as
appropriate.
2. TO (RECEIVER) Use proper name and/or HICS position title as appropriate to identify for whom the
message is intended.
3. DATE RECEIVED Use the international standard date notation YYYY-MM-DD, where YYYY is the year, MM
is the month of the year between 01 (January) and 12 (December), and DD is the day of the month between
01 and 31. For example, the fourteenth day of February in the year 2006 is written as 2006-02-14.
4. TIME RECEIVED Use the international standard notation hh:mm, where hh is the number of complete hours
that have passed since midnight (00-24), and mm is the number of complete minutes that have passed since
the start of the hour (00-59). For example, 5:04 PM is written as 17:04. Use local time.
5. RECEIVED VIA Indicate communication system.
6. REPLY REQUESTED Indicate whether a reply was requested and to whom reply should be addressed, if
different from Sender.
7. PRIORITY Indicate level of urgency of the message.
8. MESSAGE (KEEP ALL MESSAGES/REQUESTS BRIEF, TO THE POINT, AND VERY SPECIFIC)
Transcribe complete, concise, and specific content of message.
9. ACTION TAKEN (IF ANY) Note any action taken in response to message. When message is routed to any
additional recipient, indicate who received, time received, action taken or other comments, and next person to
whom message was forwarded.
10. FACILITY NAME Use when transmitting the form outside of the hospital.
WHEN TO COMPLETE: When intended Receiver is unavailable to speak with the sender or when a
communication includes specific details which accuracy needs to be ensured.
HELPFUL TIPS: This form is suitable for duplication using carbonless copy paper.

INCIDENT MESSAGE FORM
1. FROM (SENDER)
2. TO (RECEIVER)
3. DATE RECEIVED 4. TIME RECEIVED 5. RECEIVED VIA 6. REPLY REQUESTED
Phone Radio Yes No
Other:
If Yes, REPLY TO (if different from Sender):
7. PRIORITY
Urgent – High Non Urgent – Medium Informational – Low
8. MESSAGE (KEEP ALL MESSAGES/REQUESTS BRIEF, TO THE POINT, AND VERY SPECIFIC)
9. ACTION TAKEN (IF ANY)
RECEIVED BY
TIME RECEIVED
Comments:
Forward To:
RECEIVED BY
TIME RECEIVED
Comments:
Forward To:
10. FACILITY NAME
PURPOSE: PROVIDE STANDARDIZED METHOD FOR RECORDING MESSAGES RECEIVED BY PHONE OR RADIO. ORIGINATION: ALL POSITIONS.
ORIGINAL TO: RECEIVER. COPIES TO: DOCUMENTATION UNIT LEADER AND MESSAGE TAKER. HICS 213

HICS 214 – OPERATIONAL LOG
PURPOSE: DOCUMENT INCIDENT ISSUES ENCOUNTERED, DECISIONS MADE, AND NOTIFICATIONS
CONVEYED.
ORIGINATION: COMMAND STAFF AND GENERAL STAFF.
COPIES TO: INCIDENT COMMANDER, PLANNING SECTION CHIEF, AND DOCUMENTATION UNIT
LEADER.
INSTRUCTIONS:
Print legibly, and enter complete information.
1. INCIDENT NAME If the incident is internal to the hospital, the name may be given by the hospital’s Incident
Commander. If the incident affects the larger community, the name may be given by a local authority (e.g.,
fire department, local EOC, etc.).
2. DATE PREPARED Use the international standard date notation YYYY-MM-DD, where YYYY is the year, MM
is the month of the year between 01 (January) and 12 (December), and DD is the day of the month between
01 and 31. For example, the fourteenth day of February in the year 2006 is written as 2006-02-14.
3. OPERATIONAL PERIOD DATE/TIME Identify the operational period during which this information applies.
This is the time period established by the hospital’s Incident Commander, during which current objectives are
to be accomplished and at the end of which they are evaluated. For example, a 12-hour operational period
might be 2006-08-16 18:00 to 2006-08-17 06:00.
4. SECTION / BRANCH Identify the Section and Branch to which the position preparing this form belongs.
5. POSITION Identify the title of the position preparing this form.
6. ACTIVITY LOG In Time column, use the international standard notation hh:mm, where hh is the number of
complete hours that have passed since midnight (00-24), and mm is the number of complete minutes that
have passed since the start of the hour (00-59). For example, 5:04 PM is written as 17:04. Use local time.
Prepare a separate Log for each date. In column for Major Events, Decisions, Made, and Notifications
Given, note significant details relating to the performance of the position’s functions.
7. PREPARED BY (SIGN AND PRINT) Use this space for the signature and printed name of the person
preparing the Log.
8. FACILITY NAME Use when transmitting the form outside of the hospital.
WHEN TO COMPLETE: Continuously as a tool used to record major decisions (and critical details as needed) at
all levels, from activation through demobilization.
HELPFUL TIPS: Completion of this Log may be delegated to recorders assigned to the Hospital Command
Center, Section Chiefs, and appropriate response levels (e.g., Units, Teams, etc.). Once complete, the Log will
be forwarded to position’s supervisor for immediate review and augmentation; copies are to be distributed at the
end of each operational period or sooner as directed by the Section Chief and/or Command Staff. This Log
provides documentation of major event response and situational decision-making that can be used later for:
briefing of relief personnel, post-incident reimbursement, quality assurance/control, continuous quality
improvement processes, identification of safety and/or exposure issues, development of corrective action plans,
and improvement of pre-event planning for future events.

OPERATIONAL LOG
1. INCIDENT NAME
2. DATE PREPARED 3. OPERATIONAL PERIOD DATE/TIME
4. SECTION / BRANCH 5. POSITION
6. ACTIVITY LOG
Time
Major Events, Decisions Made, and Notifications Given
7. PREPARED BY (SIGN AND PRINT)
8. FACILITY NAME
PURPOSE: DOCUMENT INCIDENT ISSUES ENCOUNTERED, DECISIONS MADE, AND NOTIFICATIONS CONVEYED. ORIGINATION: COMMAND STAFF AND GENERAL STAFF.
COPIES TO: INCIDENT COMMANDER, PLANNING SECTION CHIEF, AND DOCUMENTATION UNIT LEADER. HICS 214
PAGE ___ OF ___

HICS 261 – INCIDENT ACTION PLAN SAFETY ANALYSIS
PURPOSE: DOCUMENT HAZARDS AND DEFINE MITIGATION.
ORIGINATION: SAFETY OFFICER.
COPIES TO: COMMAND STAFF, GENERAL STAFF, BRANCH DIRECTORS, AND UNIT LEADERS.
INSTRUCTIONS:
Print legibly, and enter complete information.
1. INCIDENT NAME If the incident is internal to the hospital, the name may be given by the hospital’s Incident Commander. If the incident affects the
larger community, the name may be given by a local authority (e.g., fire department, local EOC, etc.).
2. DATE PREPARED Use the international standard date notation YYYY-MM-DD, where YYYY is the year, MM is the month of the year between 01
(January) and 12 (December), and DD is the day of the month between 01 and 31. For example, the fourteenth day of February in the year 2006 is
written as 2006-02-14.
3. TIME PREPARED Use the international standard notation hh:mm, where hh is the number of complete hours that have passed since midnight (00-
24), and mm is the number of complete minutes that have passed since the start of the hour (00-59). For example, 5:04 PM is written as 17:04. Use
local time.
4. HAZARD MITIGATION Identify the potential and actual hazards associated with the incident, from which specific Sections or Braches are at risk;
identify Section or Branch and location. Define measures to mitigate hazard, including personal protective equipment (PPE), precautions, etc. Safety
Officer or designee to sign when mitigation is implemented.
5. SAFETY OFFICER User proper name to identify Safety Officer who has completed the analysis.
6. FACILITY NAME Use when transmitting the form outside of the hospital.
WHEN TO COMPLETE: Prior to safety briefing that is part of shift briefings conducted for all staff at the start of each operational period.
HELPFUL TIPS: Identification of safety issues is an ongoing process. Hazards and risks should be reported immediately and proper mitigation measures
identified and implemented as quickly as possible. This may include cessation of operations if deemed necessary by the Safety Officer to protect the
health and safety of responders and the general public, until the hazard or risk has been mitigated. This document identifies specific existing or potential
safety risks and hazards and documents assignments as well as progress/completion of mitigation activities. This information is included in the
operational period briefing by the Planning Section Chief and archived by the Documentation Unit Leader.

INCIDENT ACTION PLAN SAFETY ANALYSIS
1. INCIDENT NAME 2. DATE PREPARED 3. TIME PREPARED
4. HAZARD MITIGATION
Potential/Actual Hazards Section or Branch and Location Mitigations Mitigation Completed
(biohazards, structural, utility, traffic, etc.) (e.g., PPE, buddy system, escape routes) (Sign Off)
5. SAFETY OFFICER 6. FACILITY NAME
PURPOSE: DOCUMENT HAZARDS AND DEFINE MITIGATION. ORIGINATION: SAFETY OFFICER. COPIES TO: COMMAND STAFF, GENERAL STAFF, BRANCH DIRECTORS, AND UNIT LEADERS. HICS 261

INCIDENT BRIEFING
G] HOSPITAL
I NCIDENT
COMMAND
SYSTEM
1. INCIDENT NAME 2, DATE OF BRIEFING 3, TIME OF BRIEFING
WfJi,­ 3//1lUll /3~{)
,
5, CURRENT ORGANIZATION
IN CIDENT COMMANDER
~, JIi1;JJ6€
]v K I /@ f/
PUBLIC INFORMATION OFFICER
fi;;CJ1~t j.~
SAFETY OFFICER
MEDICAL{TECHNICAL SPECIALISTISI
/'
1 7Z:0'6'~';
t. /-hJnu;V (~ )J ,J. lJdows/L/'
STAGING MANAGf~(jY@Jl1.V
PLANNING SECTION CHIEF LOGISTICS SECTION CHIEF FINANCE/ADMIN ISTRATION
f· 1/JuJeI/ PIJ-M JV1 U.SU;;;~O
(JmfIJ /3/rtftrId
-
D- f f)!J) IMAJ
BRA",r _ 4"lIrlr!IfJER BRANCH DIR ECTOR/UNIT LEADER
J rl j ~ /l. ("-fA J.'-;-
BRANtH' j:51R'Et'1'~ R/~t tEA6~R BRANCH DIRECTOR/UNIT LEADER BRANCH DIR ECTOR/UNIT LE ADER
6r 1l1tJMJg V I­ ~
/J
BR~n:nFU "'IT L~~r,-~, ' ......... ·cr'/"TOR/UNIT LEADER
~ IV'~ t--'-­ 1'''
/i-. (}jA-p1A/bJ
~ (!'tA
(5U/t
PURPOSE: DOCUMENT INITIAL RESPO,\SE INFORMATIO N AND AC TI ONS TAKEN AT STARTUP, ORIGINATION: INC IDE COMMANDER. Hies 201
COPIES TO COMMAND STAFF, SECT ION CHIEFS, AND DOCUMENTATION UNIT LEADER
PAGE 1 OF 2

HOSPITAL
INCIDENT
COMMAND
INCIDENT OBJECTIVES r:J
1 SYSTEM
1. INC IDENT NAM E
Wll-t­
,
- 6:-wEATHER / r;,NVIRO NMENTAL IMPLICATIONS FOR PERIOD (INCLUDE AS APPROPRIATE: FORECAST. WIND SPEED/DIRECTION, DAYLIGHT)
~ t; 3 tI - 3tJ I /h;~--/f 't1t!+. W~&f­
- --'I~ll --=--;tJ7u --l""'M/;fir-I7JM1th(/o/------2&AJIO~
7. GENERAL SAFETY / STAFF MESSAGES TO BE GIVEN
Examples: pe~on;1 Protective Eq Uipment (PPE!. Precautions, Case Definitions (refer t
HICS 261 Incident Action Plan Safety Analysis)
~aMd -~IlL= - t1TLflj)dIL .~~ ... ~~­
t -~ ()AI /tt;~-4#-fj/Jf-c:itt¢r-11AJtlAIN~
=~)u;JVI___ j7J/V t1rtf;-=-avl1Ct ~~;7 _- U IMlZf:1P·····_---=-_ _
8. ATTACHMENTS (MARK IF ATTACHED)
.~ICS 203 - Organization ASSignment List o HICS 206 - Medical Plan 0 Traffic Plan
~ICS 204 - Branch ASSignment List o HICS 251 - Facility System Status Report 0 InCident Map
o HICS 205 -Incident Communications Plan o HICS 261 - Incident Action Plan Safety Analysis 0 Other
9.PRf}AAE~ANNING SECTION CHIEF)
f--- 'J IM
11. FACILITY NAME
J1J /-ft/
PURPOSE: DEFIN E OB,.E CTIVES A \JD ISS UES FOR O P E RAT IONA~ PER IOD ORIGINATION: PLANNING SECTION CHIEF.
COPIES TO: COMMAND STAFF. GENERAL STA FF, AND DOCUM ENTATION UNIT LEADER.
Hies 202

ORGANIZATION ASSIGNMENT LIST
1. INCIDENT NAME
,...­
j11J )f~
1-7!l£
--3 ~~IM .T ~ E~~~ P R E~-~~-------------------
PA R E D
2. DATE PREPARED 4. OPERATI ONAL PERIOD DATEfTlME
PosmON
3/t1!U/I
5. INCIDENT COMMANDER AND STAFF
Incident Commander
Public Information Off ice r
L,a lson Officer
Safety Officer
MedicalfTechnlcal Special ist IType)
Medica lfTechnlcal Special.st (Type)
MedicalfTedlnlcal Specialist IType)
MedlcalfTechnlcal Specialist (Type)
Medical/Technical Specialist (Type)
MedicallTecl,nical SpeciaHst (Type )
7
NAME/AGENCY
/JOtJ- 19{)CJ
Cl
HOSPITAL
INCIDENT
COMMAND
SYSTEM
6. OPERATIONS SECTION
Chief
Staging Manager
Medical Care Branch
Infrastr ucture Bra nch
HalMat Br anch
Security Branch
Busin ess Continuity Branch
(Other) Branch
7. PLANNING SECTION
Chief
Resources Unit
Situatioll Urll t
Docu mentation Unit
Demobilization Unit
8. LOGISTICS SECTION
Chi ef
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P ·~GE OF

2011 Integrated Medical, Public Health Preparedness and Response Training
May 2, 2011
Name of Participant: (Optional) ________________________________ Facility/Organization____________________
Directions:
On a scale of 1 to 5, rate each category by circling the number that best reflects your opinion.
5 = excellent, 4 = above average, 3 = average, 2 = fair, 1 = poor.
Overall program rating:
Excellent Above average Average Fair Poor
Based on your published materials, how well were the objectives met
Exceeded expectations Equal to expectations Less than expected
To what extent did the physical environment contribute to the learning experience 5 4 3 2 1
Comments: _______________________________________________________________________________________________
To what extent did the written materials contribute to the learning experience 5 4 3 2 1
Comments:
To what extent did the program provide you with useful information 5 4 3 2 1
Comments: _______________________________________________________________________________________________
Please rate the faculty on the same scale.
Overall Teaching Effectiveness of Effectiveness of
Effectiveness Teaching Methods Educational Materials
Advanced HICS and IAP Planning
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Comments:
HICS – The Evolution Continues
5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Comments:

Would you recommend this program to others Yes No
If not, will you share your reasons why
What did you like best about this course
What suggestions do you have for making the course better
If you have additional comments that you would like to include please write them in the space below.
Thank you for attending today’s session!