Your browser does not support JavaScript!
This form cannot automatically check that you have submitted all of the required fields without JavaScript.
Please be sure to submit all required fields (marked with stars).

Community Memorial Health Care

HICS201-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: Fill out this electronic form and enter complete information.

1.INCIDENT NAME If the incident is internal to the hospital, the name may be given by the hospitalís 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.

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.

You might also access the job action sheets with organizational delegations.
Fill out the electronic form below.
* Incident Name
* Date Prepared
* Time Prepared
Operational Period Date/Time
* From
* To
Briefing
* Incident Location
  Map Attached? Yes     No    
  Brief Summary of Incident
  Current / Completed Actions
  Current Organization Command
Safety
Liaison
PIO
Operations
Logistics
Planning
Finance/Admin
Intel/Situation
Resources Summary
  Ordered
  Identification
  ETA
  On Scene
  Location
* Prepared By
* Approved By