RHCC SITUATION REPORT

NUMBER
TITLE
INSTRUCTIONS
1 Incident Name Enter the name assigned to the incident.
2a & 2b Operational Period Enter the start date (m/d/y) and time (12 hour clock) and end date and time.
3a & 3b Facility Name &
Type
Enter the name of the facility and type
4a , 4b,
4c & 4d
Contact Info Contact name, phone, cell phone and email
5 Status Normal: 100% operable with no limitations
Modified: Operable or somewhat operable with limitations
Limited: Partial functional some assistance needed
Impaired: Major assistance needed
Not functional: Major assistance needed
Unknown: Not applicable, do not have info
6 Communications Email, land line phone, fax, internet, cell phone, satellite phone, HEART amateur radio
7 Utilities Power, water, sanitation, heating, A/C, ventilation
8 Evacuation Evacuating: Partial evacuation, Total evacuation, Shelter in Place.
9 Impact/Casualties Immediate (Red): Critical care
Delayed (Yellow): Moderate care
Minor (Green): Care not needed immediately
Fatality (Black): Deceased
10 Additional Information Internal disaster plan activated?
Facility Command Center activated?
Emergency generator power in use?

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INCIDENT STATUS REPORT
{var Title}

1. Incident Name: {var incidentname} 2. WebEOC Incident (as applicable): {var WEBEOC}
3. Incident Date/Time: {var IncDateTime} 4. Report Version: {var Rversion}
5. Type of Incident (Check all that apply):
Severe Storm/Flood Pre-Planned Event HAZMAT
Severe Winter Weather Dam/Levee Utility Disruption
Public Health Active threats/ Civil Disturbance Earthquake
Fire Aircraft Disaster Other (Specify): {var Typeother}

6. Situation Summary as of Time of Report:

{var SitSummary}

7. Future Outlook/Goals/Needs/Issues:

{var Issues}

8. County Emergency Operations Center (EOC) Status (Check one):
{var EOCStatus}
Hours of Operation: {var hoursofop} {var hoursmonitor}
9. Local Disaster Declaration Status (Check one):
{var Declaration}    {var DecDateTime}
10. Number of Confirmed Incident Injuries: {var numInjuries} 11. Number of Confirmed Incident Fatalities: {var numiFatalities}

12. Number and Location(s) of Shelters Established:

{var Shelters}

13. Have Evacuations Been Implemented?

{var Evac}
{var Evacyes}

14. Date/Time of Report:
  {var DateTimeReport}
15. Report Submitted By:
  {var Submittedby}
16. Contact Info:
  {var Contctinfo}

    Version 2.3