Emergency Preparedness

Appendix O.8 HICS 251 FACILITY SYSTEM STATUS REPORT

 Nonfunctional  N/A

External Lighting

 Fully functional  Partially functional  Nonfunctional  N/A  Fully functional  Partially functional  Nonfunctional  N/A  Fully functional  Partially functional  Nonfunctional  N/A  Fully functional  Partially functional  Nonfunctional  N/A

External Storage Equipment

External Storage Vehicles

Parking Structures, Lots

(Power, panic alarms, access, egress, lighting)

Landing Zone Pads, lighting, fuel source  Fully functional  Partially functional  Nonfunctional  N/A 7. Remarks (Cracked walls, broken glass, falling light fixtures, etc.)

8. Prepared by

____________________________________________________________

__________________________________________________________

PRINT NAME:

SIGNATURE:

______________________________________________________________

FACILITY: ______________________________________________________________

DATE/TIME:

Patient Decontamination Recommendations for Hospitals v July 2005 373