ICS Forms - West Virginia Division of Homeland Security

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# ofPersons1. Incident Name: 2. Operational Period:Date From:Time From:ASSIGNMENT LIST (ICS 204)Date To:Time To:4. Operations Personnel: Name Contact Number(s)Operations Section Chief:Branch Director:Division/Group Supervisor:5. Resources Assigned:Resource IdentifierLeaderContact (e.g., phone, pager, radiofrequency, etc.)3.Branch: 1Division: 1Group: 1Staging Area: 1Reporting Location,Special Equipment andSupplies, Remarks, Notes,Information6. Work Assignments:7. Special Instructions:8. Communications (radio and/or phone contact numbers needed for this assignment):Name/FunctionPrimary Contact: indicate cell, pager, or radio (frequency/system/channel)////9. Prepared by: Name: Position/Title: Signature:ICS 204 IAP Page _____ Date/Time:
ICS 204Assignment ListPurpose. The Assignment List(s) (ICS 204) informs Division and Group supervisors of incident assignments. Once theCommand and General Staffs agree to the assignments, the assignment information is given to the appropriate Divisionsand Groups.Preparation. The ICS 204 is normally prepared by the Resources Unit, using guidance from the Incident Objectives (ICS202), Operational Planning Worksheet (ICS 215), and the Operations Section Chief. It must be approved by the IncidentCommander, but may be reviewed and initialed by the Planning Section Chief and Operations Section Chief as well.Distribution. The ICS 204 is duplicated and attached to the ICS 202 and given to all recipients as part of the IncidentAction Plan (IAP). In some cases, assignments may be communicated via radio/telephone/fax. All completed originalforms must be given to the Documentation Unit.Notes:The ICS 204 details assignments at Division and Group levels and is part of the IAP.Multiple pages/copies can be used if needed.If additional pages are needed, use a blank ICS 204 and repaginate as needed.BlockNumberBlock TitleInstructions1 Incident Name Enter the name assigned to the incident.2 Operational PeriodDate and Time FromDate and Time To3 BranchDivisionGroupStaging Area4 Operations PersonnelName, Contact Number(s)– Operations Section Chief– Branch Director– Division/Group SupervisorEnter the start date (month/day/year) and time (using the 24-hourclock) and end date and time for the operational period to which theform applies.This block is for use in a large IAP for reference only.Write the alphanumeric abbreviation for the Branch, Division, Group,and Staging Area (e.g., “Branch 1,” “Division D,” “Group 1A”) in largeletters for easy referencing.Enter the name and contact numbers of the Operations Section Chief,applicable Branch Director(s), and Division/Group Supervisor(s).5 Resources Assigned Enter the following information about the resources assigned to theDivision or Group for this period:5(continued)Resource IdentifierLeaderThe identifier is a unique way to identify a resource (e.g., ENG-13,IA-SCC-413). If the resource has been ordered but no identificationhas been received, use TBD (to be determined).Enter resource leader’s name.# of Persons Enter total number of persons for the resource assigned, including theleader.Contact (e.g., phone, pager,radio frequency, etc.)Reporting Location, SpecialEquipment and Supplies,Remarks, Notes, InformationEnter primary means of contacting the leader or contact person (e.g.,radio, phone, pager, etc.). Be sure to include the area code whenlisting a phone number.Provide special notes or directions specific to this resource. Ifrequired, add notes to indicate: (1) specific location/time where theresource should report or be dropped off/picked up; (2) specialequipment and supplies that will be used or needed; (3) whether or notthe resource received briefings; (4) transportation needs; or (5) otherinformation.
Page 1: National IncidentManagement SystemI
Page 6 and 7: INCIDENT BRIEFING (ICS 201)1. Incid
Page 8: INCIDENT BRIEFING (ICS 201)1. Incid
Page 11 and 12: BlockNumberBlock Title8 Current and
Page 13 and 14: ICS 202Incident ObjectivesPurpose.
Page 15 and 16: ORGANIZATION ASSIGNMENT LIST (ICS 2
Page 17: BlockNumberBlock TitleInstructions6
Page 21 and 22: 1. Incident Name: 2. Date/Time Prep
Page 23 and 24: BlockNumber4(continued)Block TitleT
Page 25 and 26: ICS 205ACommunications ListPurpose.
Page 27 and 28: ICS 206Medical PlanPurpose. The Med
Page 29 and 30: 3. Organization ChartINCIDENT ORGAN
Page 31 and 32: SAFETY MESSAGE/PLAN (ICS 208)1. Inc
Page 33 and 34: INCIDENT STATUS SUMMARY (ICS 209)*1
Page 35 and 36: INCIDENT STATUS SUMMARY (ICS 209)*1
Page 37 and 38: ICS 209Incident Status SummaryPurpo
Page 39 and 40: BlockNumberBlock TitleInstructions2
Page 41 and 42: BlockNumberBlock TitleAPPROVAL & RO
Page 43 and 44: BlockNumberBlock Title27 Note any e
Page 45 and 46: BlockNumberBlock TitleInstructionsA
Page 47 and 48: BlockNumber*32(continued)Block Titl
Page 49 and 50: BlockNumberBlock Title35 Weather Co
Page 51 and 52: BlockNumberBlock Title39 Critical R
Page 53 and 54: BlockNumberBlock Title47 Remarks (o
Page 55 and 56: BlockNumberBlock TitleInstructions5
Page 57 and 58: ICS 210Resource Status ChangePurpos
Page 59 and 60: ICS 211Incident Check-In ListPurpos
Page 61 and 62: BlockNumberBlock Title16 Data Provi
Page 63 and 64: ICS 213General MessagePurpose. The
Page 65 and 66: ACTIVITY LOG (ICS 214)1. Incident N
Page 67 and 68: 3. Branch4. Division, Group,or Othe
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BlockNumberBlock TitleInstructions1
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ICS 215AIncident Action Plan Safety
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ICS 218Support Vehicle/Equipment In
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ICS 219Resource Status Card (T-Card
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ICS 219-1: Header CardBlock TitlePr
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ICS 219-2: Crew/Team CardBlock Titl
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ST/Unit: LDW: # Pers: Order #:ST/Un
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Block TitlePrepared byDate/TimeInst
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ICS 219-4: Helicopter CardBlock Tit
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ICS 219-5: Personnel CardBlock Titl
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ICS 219-8: Miscellaneous Equipment/
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1. Incident Name: 2. Operational Pe
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BlockNumberBlock Title8 Frequencies
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ICS 221Demobilization Check-OutPurp
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BlockNumberBlock Title10 Prepared b
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INCIDENT PERSONNEL PERFORMANCE RATI
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BlockNumberBlock TitleInstructions4
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ICS 209, Page 1 of ___StructuresOth
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BAYVIEW TORNADO ICS-209*1. Incident
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FinanceLogisticsRequestorRESOURCE R
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ICS Forms - West Virginia Division of Homeland Security

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