Physician Services Emergency Preparedness Program Form
Associated Event: Please select "No Event Selected" from the drop down box below.
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
Community Care Network
Home Med Equipment
Imperial Lab & X Ray
Methodist Comprehensive Care
Methodist Family East
Methodist Family Med. McClellan
Methodist Family Med Moore
Methodist Family Med Rightmyer
Methodist Family Med. Sebree
Methodist Family Med. Sturgis
Methodist Family Med. Wilder
Methodist Family Practice
Methodist Surgical Serv.
Methodist Woman's Serv.
Tri-County Medical Collections
Webster Co. Family Medicine
Type of program
Date of Activation
Number of participants
Describe evacuation of patients/visitors/staff to safe site/location
Other actions taken
Time of all clear
Were all patients/visitors & staff members accounted for at the evacuation site?
Where all involved staff members familiar with codes, routes, procedures, etc?
Was evacuation conducted in a safe manner through halls, down stairs, etc?
Office searched for patients, visitors, and/or staff in preparation for evacuation?
Able to state designated safe site/gathering evacuation spot?
Was the overall evacuation conducted in a manner indicating thorough knowledge of procedures by all personnel involved?
Evaluated By :