Emergency Management Plan Revision of May 1, 2011



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    1. INCIDENT COMMAND FORMS



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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