5. FACILITY OPERATING STATUS
Normal |
Modified partially functional - no assistance needed (explain) |
Limited partially functional,- Some assistance needed (explain) |
UNKNOWN |
Impaired- major assistance needed (explain) |
Not functional major assistance needed (explain) |
|
Ability to provide essential care services |
{var A5a}
|
{var Comments5} |
6. COMMUNICATIONS Impacted {var commipaired} |
6a. Email |
{var A6a} |
6b. Landline Phone |
{var A6b} |
6c. Fax |
{var A6c} |
6d. Internet |
{var A6d} |
6e. Cell Phone |
{var A6e} |
6f. Satellite Phone |
{var A6f} |
6g. Amateur Radio |
{var A6g} |
6h.{var Comments6} |
7. UTILITIES Impacted: {var utilitiesimpared} |
7a. Power |
{var A7a} |
7b. Water |
{var A7b} |
7c. Sanitation |
{var A7c} |
7d.Heating/Ventilation/AC |
{var A7d} |
{var Comments7} |
8. EVACUATIONS {var evacConcerns} |
8a. Evacuating? |
{var Evac8} |
{var A8a} |
8b. Partial Evacuation |
{var Partial8} |
{var A8b} |
8c. Total Evacuation |
{var Total8} |
{var A8c} |
8d. Shelter in place |
{var Shelter8} |
{var A8d} |
{var Comments8} |
|
9. CASUALTIES {var thereArecausalties} |
Immediate injuries = Critical care needed RED |
Estimated #
{var Immediate9} |
|
Delayed injuries = Moderate care needed YELLOW |
Estimated #
{var Delayed9} |
Minor injuries = Care not needed immediately GREEN |
Estimated #
{var Minor9} |
Fatalities BLACK = Deceased |
Estimated #
{var Fatalities9} |
{var Comments9} |
10. ADDITIONALI NFORMATION: |
Internal disaster plan activated? |
{var plan10a} |
Facility Command Center activated? |
{var FCCActive10} |
Emergency generator power in use? |
{var generator10} |
Will you send Resource Request within 4 hours? |
{var ResourceRreq10} |
{var Comments10} |
Version 2.1 |