HICS INCIDENT ACTION PLAN (IAP) QUICK START
COMBINED HICS 201—202—203—204—215A 
  

1. Incident Name:  
{var IncidentName}

2. Operational Period: {var opperiod} Date From: {var DateFrom} Date To: {var DateTo}
  Time From: {var TimeFrom} Time To: {var TimeTo}
3. Situation Summary      
 — HICS 201 —

  {var SituationSummary}

4. Current Hospital Incident Management Team (fill in additional positions as appropriate)
—HICS201,203—
Incident Commander (s)
{var IC}
Command Staff General Staff
Public Information Officer: {var PIO}
Operations Chief: {var Ops}
Liaison Officer: {var Liaison} Planning Chief: {var Planning}
Safety Officer: {var Safety} Logistics Chief: {var Logistics}
Medical-Technical Specialist: {var Med1} Finance/Administration Chief: {var Finance}
Medical-Technical Specialist: {var Med2}  
Medical-Technical Specialist: {var Med3}  
Medical-Technical Specialist: {var Med4}  
IAP Quick Start page N1        
     
5. Health and Safety Briefing Identify potential incident health and safety hazards and develop necessary measures (remove hazard, provide personal protective equipment, warn people of the hazard) to protect responders from those hazards.
— HICS 202, 215A —

 {var HealthSafety}
6. Incident Objectives
— HICS 202, 204 —

6a. OBJECTIVES 6b. STRATEGIES / TACTICS 6c. RESOURCES REQUIRED 6d. ASSIGNED TO
{var Obj1} {var tactic1} {var resource1} {var assign1}
{var Obj2} {var tactic2} {var resource3} {var assign2}
{var Obj3} {var tactic3} {var resource3} {var assign3}
{var Obj4} {var tactic4} {var resource4} {var assign4}
{var Obj5} {var tactic5} {var resource5} {var assign5}

7. Prepared by: Name {var Prepedby}    Signature: {var Prepsig}

     Date/Time: {var DateTime}         Facility: {var Facility}  

IAP Quick Start page 2    

HICS Quick Start Ver 0.3   

More Information

You can save your completed HTML to a text file. This will allow you to reload the Form with ALL entered form data. You do this prior to submitting the form. Then you can open a new Form and load the saved HTML form data. NOTE: Date and Times will be the previous, so change if needed. It will save the info as a text file with the Date and Time as the text file name. Now you can use any browser, save your form, (as many versions as you like), and then re-ate.

You can change the form title to reflect your group or agency name. Just use the SETUP button on forms top left and enter what you wish. It will remian as such until you change it. * NOTE on printing:

Printing this form is dependent upon your selected printer and its settings. Various Web Browsers and and their viewing sizes are not all the same. Printing from a browsers print function may be different from the operating systems default print mode. Select what works for you, for both printing and viewing. You may print direct to the printer as a HTML or save as a PDF then print the PDF. In some instances Landscape mode may print better than Portrait.

.

Back to links