Psychosociale Hulpverlening bij Ongevallen en Rampen - Impact
Psychosociale Hulpverlening bij Ongevallen en Rampen - Impact
Psychosociale Hulpverlening bij Ongevallen en Rampen - Impact
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<strong>Psychosociale</strong> <strong>Hulpverl<strong>en</strong>ing</strong> <strong>bij</strong> <strong>Ongevall<strong>en</strong></strong> <strong>en</strong> Ramp<strong>en</strong><br />
Bijlage 9:<br />
Meldingsformulier<br />
Dit formulier is bestemd voor de receptie van de diverse instelling<strong>en</strong> tijd<strong>en</strong>s kantoorur<strong>en</strong> <strong>en</strong> voor de<br />
betrokk<strong>en</strong> functionariss<strong>en</strong>/instelling<strong>en</strong> die als 1 e in aanmerking kom<strong>en</strong> voor het binn<strong>en</strong>krijg<strong>en</strong> van e<strong>en</strong><br />
alarmering in het kader van de PSH.<br />
Datum: ................................................................................................................................................................<br />
Tijdstip: ..............................................................................................................................................................<br />
Naam medewerker: ......................................................................................................................................<br />
<br />
<br />
Naam melder <strong>en</strong> instantie:............................................................................................................................<br />
Telefoonnummer melder:.............................................................................................................................<br />
Meldinggegev<strong>en</strong>s<br />
Aard <strong>en</strong> omvang calamiteit: .........................................................................................................................<br />
............................................................................................................................................................................<br />
............................................................................................................................................................................<br />
Indi<strong>en</strong> bek<strong>en</strong>d:<br />
Aantal slachtoffers: .............................................. Aantal dod<strong>en</strong>:................................................................<br />
<br />
Aantal kinder<strong>en</strong>:...........................................................................................................................................<br />
Is er e<strong>en</strong> opvangc<strong>en</strong>trum ingericht? Ja Nee<br />
Waar:............................................................................................................................................................<br />
Hoeveel person<strong>en</strong> word<strong>en</strong> daar verwacht?<br />
± ............Person<strong>en</strong><br />
<br />
Zijn er meerdere nationaliteit<strong>en</strong> <strong>bij</strong> betrokk<strong>en</strong>? Zo ja, welke<br />
............................................................................................................................................................................<br />
46<br />
14 november 2005
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