Block# |
Block Title |
Instructions |
1 |
Incident Name |
Enter the name assigned to the incident |
2 |
Date/Time Prepared |
Enter date prepared (month/day/year) and time prepared (using the 24-hour clock) |
3 |
Operational Period
• Date and Time From
• Date and Time To |
Enter the start date (month/day/year) and time (using the 24-hour clock) and end date and time for the operational period to which the form applies |
4 |
Information Technology Infrastructure & Services |
Enter the following information: |
Assignment |
Enter the ICS position, unit assignment or intended audience utilizing the application/service |
IT Resource Type |
Use Form 205B, information technology Plan to identify how information is transmitted (via a voice, video or data network) |
Name of Application or Resource |
Enter the name or title of the application/service |
Usage or Description |
Enter the intended usage or description of the application/service |
Platform |
Enter the hardware platform and/or operating system supported by the application |
Developer |
Enter the name of the application developer |
Login / Install |
Enter the basic login or install instructions this may include listing the system administrator or POC for the application/service |
Equipment Location
Web Address, IP Address or SSID |
• For IT Infrastructure list the location of the equipment
• For wireless access list SSID
• For cloud-based applications enter the web address used to access the site
• For mobile apps or software applications that require installation list the application source |
POC Information |
Enter POC Name and contact information |
Remarks |
Enter general information about the voice, video or data application that would be useful to end users |
5 |
Prepared by
• Name
• Phone
• Signature
• Date/Time |
Enter the name, phone number and signature of the person preparing the form, typically the IT Service Unit Leader. Enter date (month/day/year) and time prepared (24-hour clock). |
6 |
Location
• State
• County
• City |
Enter Incident Location Address, State, County and City |