Emergency Incident Message Form
Use this form to submit your Initial check in with the Command Center every time an emergency situation is announced.
All departments/units who do not submit a "Patient Unit Report" at the start of a DRS' ALERT PH I or II must include their staffing level on this form.
1663 - 3-14-19 Code T Black (Emergency initiated on 2019-03-14 09:47:03)
1661 - Region 3 Disaster Drill 3-13-19 (Drill initiated on 2019-03-12 13:51:34)
1647 - Security 2019 (Drill initiated on 2019-01-07 14:12:10)
1533 - Current Event 2018 (Drill initiated on 2018-01-02 08:11:47)
1531 - Maintenance 2018 (Drill initiated on 2018-01-02 08:11:07)
1529 - Security 2018 (Drill initiated on 2018-01-02 07:29:22)
1523 - November 3, 2017 Community Disaster Drill (Drill initiated on 2017-11-06 11:34:30)
993 - Union Co Spirit Spotlight Pres (Survey initiated on 2014-01-07 08:27:57)
851 - Spirit Spotlight Nominations (Survey initiated on 2013-05-30 14:49:06)
307 - Training (Drill initiated on 2010-10-27 14:05:21)
No Event Selected
MESSAGE TO COMMAND CENTER
This form is used to report departmental information directly to Command Center. (telephone extensions 7501 & 7502
Is Department ready to accept emergency victims/patients?
Empty beds available on this unit for expansion?
Telephone ext. # of
Date & Time:
Priority of Message
Total Staff Members Available
Number of RNs (if applicable)
Please be descriptive and include all known details, names of those involved, time occurred, etc.