Emergency Management Plan Revision of May 1, 2011

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RESERVED for future use.

INCIDENT BRIEFING	Incident Type	Incident Name
Date Prepared	Time Prepared	BRIEFING HELD (Date & Time)
Incident Description / Summary






Current Organization

9. Prepared by (Name and Position)			Page 1 of 3 _

INCIDENT BRIEFING			Incident Type	Incident Name
Summary of Events / Actions
Date	Time	Events / Actions

























Prepared by (Name and Position)					Page 3 of 3 _

INCIDENT OBJECTIVES	Incident Type	Incident Name
Date Prepared	Time Prepared	Operational Period (Date & Time) FROM TO
Overall Incident Objectives





Specific Objectives for this Operational Period













Safety Message / Instructions for this Operational Period



Weather forecast for this Operational Period


Prepared by (Name and Position)			Page of _

CHECK-IN LIST Personnel		Incident Type				Incident Name
Check-In Initiated (Date & Time)		Check-In Location				Operational Period (Date & Time) FROM TO
Personnel Check-In Information
Time IN	Name		Time TASKED	ISF #	Position or Assignment			Time OUT





















Prepared by (Name and Position)							Page of _

UNIT LOG		Incident Name	Date
Department / ISF # and Name		Unit Leader (Name and Position)	Operational Period (Date & Time) FROM TO
Personnel Roster Assignment
Name		Responsibility / Function	Home Base / Work Location










Activity Log
Time	Major Events or Activities















Prepared by (Name and Position)				Page ____ of _____

MEETING SUMMARY		Incident Type		Incident Name
Meeting Name / Type		Meeting Date & Time		Meeting Location
Meeting Leader / Facilitator		Ending Time		Total Time
Attendees
1.		7.		13.
2.		8.		14.
3.		9.		15.
4.		10.		16.
5.		11.		17.
6.		12.		18.
NOTES:









Action Items
#	Action Item		Assigned To		Deadline	Done
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Prepared by (Name and Position)					Page of _

SITUATION REPORT (SITREP)	Incident Name	SITREP No.
Date	Time Prepared	Prepared By
Water System
Water Storage %	Avg Sys Pressure PSI
1 ___Normal ___Shutdown ___No Power ____% Storage ___HSP on Gen
2 ___Normal ___Shutdown ___No Power ____% Storage ___HSP on Gen
3 ___Normal ___Shutdown ___No Power ____% Storage ___Plant on Gen
4 ___Normal ___Shutdown ___No Power ____% Storage ___Plant on Gen
??? ___Normal ___Shutdown ___No Power ____% Storage ___HSP on Gen
Wastewater System
???? ___Normal ___Shutdown ___No Power ___on Generator
???? ___Normal ___Shutdown ___No Power ___on Generator
Number of Pump Stations without Power __________

Number of Pump Stations in High Water

Other:


Prepared by (Signature and Position)			Page ____ of _____

SITREP

TO VIEW THE ENTIRE “NATIONAL INCIDENT MANAGEMENT SYSTEM”

DOCUMENT,VISIT WWW.FEMA.GOV/NIMS ON THE INTERNET.

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