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}