INCIDENT COMMAND SYSTEM (ICS) FORMS FOR PORTLAND NET
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Page 1 of 34 NETs recording information INCIDENT COMMAND SYSTEM (ICS) FORMS FOR PORTLAND NET ICS forms provide a template to NET volunteers for documenting activities during a deployment. Though efforts to save life and property take priority over response documentation, documenting activities is nonetheless important and should be a routine part of NET training, drills, and response. Documentation serves several crucial functions: Documentation passed on to other emergency responders will help them understand the status of resources, and allow them to deploy their own resources effectively and appropriately. Good documentation saves time, and therefore, lives. Liability exposure for volunteers will be documented. Communication will be improved between functional areas and between shifts. Thorough documentation facilitates reimbursements from FEMA. The purpose of this ICS forms packet is to: Clarify the responsibilities each team position in a deployment (e.g. Team Leader, functional team, logistics coordinator) has for documenting activities. Specify what the recommended forms are, and how they are used. Demonstrate how the documentation “flows” through the incident response. It is accepted and understood that ICS forms are not required for documenting operations; in a pinch, a sheet of ordinary notebook paper will suffice. The benefit of the forms is that they guide NET volunteers to documenting the most relevant information and help them to fulfill their duties. In this respect, ICS forms are not so much cumbersome paperwork as they are a helpful tool.
Transcript of INCIDENT COMMAND SYSTEM (ICS) FORMS FOR PORTLAND NET
Page 1 of 34
NETs recording information
INCIDENT COMMAND SYSTEM (ICS) FORMS FOR PORTLAND NET ICS forms provide a template to NET volunteers for documenting activities during a deployment. Though efforts to save life and property take priority over response documentation, documenting activities is nonetheless important and should be a routine part of NET training, drills, and response. Documentation serves several crucial functions:
� Documentation passed on to other emergency responders will help them understand the status of resources, and allow them to deploy their own resources effectively and appropriately. Good documentation saves time, and therefore, lives.
� Liability exposure for volunteers will be documented.
� Communication will be improved between functional areas and between shifts.
� Thorough documentation facilitates reimbursements from FEMA.
The purpose of this ICS forms packet is to:
� Clarify the responsibilities each team position in a deployment (e.g. Team Leader, functional team, logistics coordinator) has for documenting activities.
� Specify what the recommended forms are, and how they are used.
� Demonstrate how the documentation “flows” through the incident response.
It is accepted and understood that ICS forms are not required for documenting operations; in a pinch, a sheet of ordinary notebook paper will suffice. The benefit of the forms is that they guide NET volunteers to documenting the most relevant information and help them to fulfill their duties. In this respect, ICS forms are not so much cumbersome paperwork as they are a helpful tool.
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The forms in this packet are based on the CERT ICS forms found in Section 600 of the CERT textbook. However, they are not exactly the same. Based on NET feedback, they have been adapted to NET methods of deployment and operations.
The Role of the Scribe PBEM recommends that each Operations Plan anticipate the need for a “scribe” or even several scribes during NET operations. Otherwise, the responsibility of tracking forms and ensuring volunteers keep proper documentation falls to the Team Leader, which compromises her/his span of control.
Every NET has volunteers who are enthusiastic to serve but who do not feel physically ready to engage hands-on in search and rescue tasks such as cribbing, lifting, or other activities that require physical exertion. Acting as the scribe for the NET, therefore, is a great job for them. Ideally, these team members are identified in the NET’s Operations Plan and, as the designated scribe, make themselves familiar with the ICS forms and ICS framework. However, acting as a scribe is also a task that can be delegated to an SUV with little training.
Furthermore, PBEM recommends that a NET have at least one scribe for the NET Staging Area, and one scribe each for the functional teams conducting search and rescue operations. For example, a Team Leader deploys five NET volunteers to a community center after an earthquake to search for survivors. Four of those volunteers will do cribbing, victim carries, extrication, and so forth; the fifth volunteer is present to document the activities of the other four (and perhaps also communicate with the Staging Area via radio). In this way, the important work of documentation gets done without diverting the attention of those volunteers carrying out physical rescue activities.
Completed forms should never be thrown away. Forms serve as a response record and will be important when requesting reimbursement from FEMA.
Documentation FlowThe most important forms to a NET are forms 1 through 4, explained below. Forms 5 through 8 are designed to supplement work at specific stations (e.g. radio, medical, logistics, etc). Any form that is filled out and is no longer of use should be kept for the NET Coordinator.
Forms 1, 3, and 4 flow in a way that outlines an anticipated NET response (see Figure 1, next page). The first form, Damage Assessment, is used by NET volunteers transiting to the NET Staging Area; the form is used to record observed damage and other trouble spots along the way.
Form 3, the Team Leader Assignment Tracking Log, acts as a “dashboard” for the Team Leader. Working with his/her team, the TL transfers any potential area of response from Damage Assessment forms collected from the team onto the Tracking Log. This tool thereby helps the TL easily track each functional team deployed from the NET staging area.
Form 4, the Assignment Briefing, is filled out by the Team Leader when she/he is ready to deploy a functional team to respond to an item on the Tracking Log. On the front, the Assignment Log has spaces for giving the functional team the information they need to get to the scene quickly and safely. The functional team then records their response actions on the reverse side, and turn the form in to the Team Leader when they return to the NET staging area. The Team Leader reviews the reverse side, transferring relevant details to his/her Tracking Log. The Assignment Briefing is then archived with the team’s Logistics section.
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Form 1 Damage
Assessment
Form 1 Damage
Assessment
Form 1 Damage
Assessment
Form 3 Assignment
Tracking Log
Form 4 Assignment
Briefing
Form 4 Assignment
Briefing
Form 4 Assignment
Briefing
Form 1 turned into TL; TL copies info to Form 3
Assignment info transferred from Form 3 to Form 4;
Form 4 given to functional team
Mission results provided to TL; TL transfers results to Form 3
Figure 1: flow of NET forms 1, 3, and 4
Tracking NumbersAs an option, NETs may use the tracking number spaces provided on some forms. Tracking numbers are not used with standard ICS forms; this is a NET embellishment.
Forms 2a through 5b provide a space for an arbitrarily assigned tracking number. Tracking numbers are for internal team use; therefore, a NET Team Leader can decide on whatever number convention works best (e.g. 0001, or simply “1”, etc).
Tracking numbers are intended as a means of connecting forms to each other where those forms are used on a specific mission; in other words, the tracking number is the same as a “mission number”.
Assigning mission numbers may make it easier for teams and emergency professionals reviewing documents to connect events.
For example, let’s say that a Team Leader sends one functional team to conduct search and rescue in a house (tracking number #001) and another functional team to establish radio communication (tracking number 002). Any forms associated with those respective missions (e.g. a medical treatment log or an assignment briefing) will also include their mission tracking number. Later, when reviewing documents, a Team Leader knows that any document with the number “001” on it is associated with the house search and rescue mission.
Again, the use of tracking numbers is optional.
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INSTRUCTIONS: NET FORM 1DAMAGE ASSESSMENT FORM
Recommended kit: 3/personal kit
Filled out by: Team Member
Turned in to: Team Leader
CERT or ICS Form equivalent: CERT Form 1
The Damage Assessment Form is the most basic and essential form in a volunteer’s kit. A volunteer uses the form to record damage observed in a neighborhood (such as fires, utility hazards, structural damage, injuries and casualties, and available access) while moving through the area to the NET Staging Area.
Upon arriving at the NET Staging Area, the volunteer turns the Damage Assessment Form in to the Team Leader. The Team Leader then uses all the Damage Assessment Forms turned in to formulate and prioritize action plans (reflected on Form 4: Team Leader’s Assignment Tracking Log).
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Recommended kit:1 per 10 team members/team kit
Filled out by:Team Scribe/Logistics
Turned in to:Team Scribe/Logistics
CERT or ICS Form equivalent: CERT Form 2
INSTRUCTIONS: NET FORM 2APERSONNEL CHECK-IN The Personnel Check-in form is used to record and track incoming CERT/NET as well as affiliated volunteers (e.g. ATVs) and SUVs. It helps the NET TL or the Logistics section understand:
� Who is on site
� When they arrived
� When/where they were assigned
� Personnel availability
SUVs should fill out NET Form 2B also. When and if assigned to a functional team or other responsibility, an SUV’s assignment should be tracked here on Form 2A.
A space is provided for an Assignment Tracking Number if a volunteer is given a field assignment with a tracking number (see NET Form 4).
This form is used by a volunteer assigned to check other volunteers in. This could be the NET scribe, but this is also an appropriate task for an SUV.
A special note on check out times: please be sure that all volunteers check out! A volunteer who does not check out is effectively “missing” and unaccounted for, which can lead to a waste of time and resources attempting to locate the volunteer.
NET Form 2A: PERSONNEL CHECK IN
Neighborhood Emergency Team: Date (yyyy/mm/dd):
NAME ID or badge #Contact
(cell or radio)Check-in
TimeAssignment Tracking
NumberCheck-out
Time
SCRIBE ______________________________________________ PAGE _______ OF _______
Incoming NET/CERT volunteers must sign in. Designate which section and team they will report to ("Assignment"). Do not forget to ask them to sign out. This must be done for every shift.Use NET Form 2B: SUV CHECK IN for spontaneous volunteers.
Biddy Wopsle
Abel Magwitch
Havisham, Estella
Gargery, Joe
Wemmick Heights 2015/08/29
Clara Barley
320007
139486
248249
22004
610738 FRS 4
FRS 4
FRS 4
FRS 4
FRS 4 12:48
13:02
13:18
13:18
14:05
16:30
16:45
16:30
16:30
16:30
Command
001
002
001
002
11Havisham
Dick Charles SUV FRS 4 14:07 16:30001
Charles Dickens SUV FRS 4 14:05 16:30002
Question: if a volunteer works more than one assignment, do you check them in again when they transition to another assignment?
Answer: if your team opts to use tracking numbers, then we recommend checking them in for the new assignment.
PRINT Last, first name: ___________________________________
Have you contacted your family? Yes No Would you like to be contacted in the future for volunteer training and work?
Yes No
Would you like to be contacted again to help with this emergency? Yes No
I understand the dangers of participating. Despite the potential dangers and risks, I will participate and I agree to assume all the risks associated with such participation. In consideration for the acceptance of my participation as a volunteer, I hereby waive, release, hold harmless, and discharge any and all claims for damages for personal injury, property damage or death, which I may have or which may hereafter accrue to me, or to my heirs or assigns, as a result of my participation as a volunteer. In addition, I agree to indemnify the City from all claims demands, suits, actions, liabilities, damages, costs or expenses resulting from or arising out of my activities. This release, waiver of liability and indemnity agreement is intended to discharge and release the City of Portland, and its agents and employees from and against any and all liability arising out of, or connected in any way with, my participation as a volunteer. It is further understood and agreed that this release, waiver of liability, and indemnity agreement is to be binding on me and my heirs and assigns.
I have carefully read this agreement and fully understand its content. I am aware that this is a release of liability and a contract between myself and the City of Portland Bureau of Emergency Management, and I sign it voluntarily and of my own free will. I furthermore certify that all information I provide is true and correct.
Do you take medication and if so, do you have access to it? Not sure Yes No N/A
Agreement of Understanding
Please identify any limitations that would affect the type of volunteer assignments you can undertake.
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
To volunteer with this emergency response, please complete this form and return it to the person who gave it to you. You will receive a brief interview as soon as possible.
Please answer the questions truthfully and as completely as possible. This information helps us find the most appropriate assignment for you.Date
Signature
NET Form 2B: SPONTANEOUS VOLUNTEER INTAKE
______________________________________________________
With my signature below, I certify that I have not been convicted of a felony since my 18th birthday.
signature or initials:
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INSTRUCTIONS: NET FORM 2BSPONTANEOUS VOLUNTEER INTAKE
Recommended kit: 30+/Team Kit
Filled out by:SUVs arriving on scene
Turned in to:Team Scribe/Logistics
CERT or ICS Form equivalent: None
NETs can track spontaneous unaffiliated volunteers (SUVs) using NET Form 2A; however, in addition, NETs must intake SUVs using this form. This intake form reflects recommendations for managing SUVs as laid out in the NET Guidelines, Section 800.65. It also helps SUVs understand what may be expected of them during disaster response operations and helps protect the City from liability.
There are two sides to the form. The front side is a legal waiver and asks questions that will help a NET
determine an SUV’s fitness for duty. The reverse side (shown to the right) is a skills and resources assessment intended to help a NET match the SUV to an appropriate assignment.
Note that the front side of Form 3 includes personal information which the NET should protect carefully. Access to these forms should be limited and controlled (for example, stored in a locking box).
Charles Dickens
C.D.
Well, I’ve been dead since 1870. Feel pretty spry though.
X
X
X
X
8/29/2015
Age: _____
Equipment/Supplies You Can ProvideFirst aid supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Spare wheelchair or crutches . . . . . . . . . . . . . . . . . . .Spare bed(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tarps or tents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Chainsaw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Bottled water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Generator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fire extinguisher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Camp stove and fuel . . . . . . . . . . . . . . . . . . . . . . . . . . .Walkie-talkie or other radio . . . . . . . . . . . . . . . . . . . . .Prybar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Blanket(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Flashlight(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Rope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skills or Experience (mark all that apply)Medical training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .First aid/CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fire fighting skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Safety and security . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Search and rescue skills . . . . . . . . . . . . . . . . . . . . . . . .Crisis counseling skills . . . . . . . . . . . . . . . . . . . . . . . . . .Office/organizational skills . . . . . . . . . . . . . . . . . . . . .Teaching skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Crowd control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Carpenter skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Chainsaw skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Electrician skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Amateur radio skills . . . . . . . . . . . . . . . . . . . . . . . . . . . .Food prep skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Commercial license . . . . . . . . . . . . . . . . . . . . . . . . . . . .non-English languages:
FOR OFFICIAL USE ONLY
ID verified (initials) ________ Accepted? Yes No
Issued ID? Yes No Badge # _____________________
NET organization/objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Weapons policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Safety awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Search and rescue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Medical triage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Assignment 1: ______________________________________________________
Assignment 2: ______________________________________________________
Waiver signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
White: Operations Manager Yellow: Planning Pink: Volunteer Lead
Home address: ______________________________________________________________
City: ___________________________ State: ______ Zip code: ______________
E-mail: ________________________________
Driver’s license (state/#): ______________________Gender: ______
Last, first name: __________________________________________________________________
Best phone: (_____) _____ - ________
Yes Fit for physical work? No Light
Emergency contact name: ______________________ Relation: _____________________
Emergency contact phone: (_____) _____ - ________
NET Form 2B: SPONTANEOUS VOLUNTEER INTAKE (reverse)
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INSTRUCTIONS: NET FORM 2BSPONTANEOUS VOLUNTEER INTAKE continuedThere is no expectation that SUVs fill out this form in the midst of conducting life safety operations. NETs should keep these forms at the command post and ask SUVs to complete the intake between assignments. The verbiage used in the legal section of the intake form may also read as intimidating to potential SUVs. Please inform SUVs that by signing, they are not “signing away” any rights or protections. The
language is only to inform SUVs that they have no indemnification from the City of Portland; they do not have this regardless whether they choose to sign.
Finally, this form has been designed for triplicate if printed on carbon paper. However, this is not required for use.
Dickens, Charles
2020 NE Startop
Portland
X
X
X
X
205 M
X
E.H X
X
X
X
XX
X
X
X
X
X
OR
none
Catherine Hogarth wife
97212
Page 8 of 34
INSTRUCTIONS: NET FORM 3TEAM LEADER ASSIGNMENT TRACKING
Recommended kit: 5+/Team Kit
Filled out by: Team Leader
Turned in to:Emergency responders
CERT or ICS Form equivalent: CERT Form 3
NET Form 3 is a “dashboard” that the NET TL uses to track active field assignments; it is a tool to facilitate situational awareness.
When at a NET staging area, volunteers turn in their damage assessment forms (Form 1). The TL uses information from the collected assessment forms to make decisions on where to deploy resources. Form 3 summarizes and tracks where those resources go.
On the example below, note the two blanks circled in red; these are optional inputs. A tracking
number may be assigned by a TL to an operation in order to associate that operation between forms. For example, a fire extinguisher may be checked out for operation 001. On the Equipment Inventory (Form 8), “001” is associated with that fire extinguisher as it is checked out and back in. Again, this is optional; it is intended to help keep the Staging Area personnel organized.
In the example to the left, the two functional teams are also given their own designations (“BLUE TEAM” and “ORANGE TEAM”). This is
done to help prevent them getting mixed up over radio traffic. These designations are optional.
Again, this form is used as a dashboard for summarizing and tracking. The details of an assignment are placed on Form 4: Assignment Briefing.
NET Form 3: TEAM LEADER’S ASSIGNMENT TRACKING LOG
Neighborhood Emergency Team Date (yyyy/mm/dd)
Assignment Assignment
Tracking # Tracking #
Location Location
Team Team
Team Leader Team Leader
Start Time End Time Start Time End Time
VOLUNTEERS ASSIGNED VOLUNTEERS ASSIGNED
1.) 1.)
2.) 2.)
3.) 3.)
4.) 4.)
5.) 5.)
Objectives Objectives
Results Results
NET LEADER: SCRIBE:PAGE ________ OF ________
Biddy Wopsle
Abel Magwitch
Gargery, Joe
Wemmick Heights
Clara Barley
13:25 14:10
001 002
HavishamDeFarge
9911 SE Bush1900 SW 4th Ave
BLUE
PDX 1900 Bldg. PBEM ECC
Gargery Wopsle
ORANGE
Confirm fire is extinguished; search for survivors if safe to do so; recruit SUVs to help.
Small fire extinguished, two survivors with minor injuries treated.
14:25
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Recommended kit: 15+/Team Kit
Filled out by:Team Leader and tactical team
Turned in to: Team Leader
CERT or ICS Form equivalent:
CERT Form 4a and 4b
INSTRUCTIONS: NET FORM 4ASSIGNMENT BRIEFING
The purpose of NET Form 4 is to provide a team deploying to an operation with relevant information about the mission, and to record the details of mission results for the TL and professional responders.
Using information from NET Form 3, the TL fills out Form 4 as completely as possible. Over the course of an operation, a scribe (who can be an
SUV detailed for the task) records the relevant decisions and actions of the NET on the reverse side. When the operation is concluded, the completed form is turned in to the Team Leader.
Completed Assignment Briefings become part of the documentation that the NET relays to the ECC and/or professional emergency responders.
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NET Form 5a: VICTIM TREATMENT AREA RECORD
Neighborhood Emergency Team Date (yyyy/mm/dd)
Treatment Area Location Tracking Number
Check-in Time
Name or DescriptionTriage Tag (circle one)
Condition/Treatment (update as needed)
Moved ToCheck-Out
Time
SCRIBE ______________________________________________ PAGE _______ OF _______
IMMED
DELAY
MINOR
IMMED
DELAY
MINOR
IMMED
DELAY
MINOR
IMMED
DELAY
MINOR
IMMED
DELAY
MINOR
The Patient Treatment Area Record is a specialized form intended to track the condition of patients placed in a patient treatment area. It is filled out by a volunteer (CERT/NET or SUV) detailed to the treatment area. Completed Treatment Area Records are turned in to the NET’s Scribe.
This form does not allow for a great deal of detail on victims’ conditions. This is acceptable for an immediate, short-term response when the presumption that emergency medical response will soon be en route.
However, if volunteers anticipate that professional responders will not be available for some time, a designated volunteer should consider tracking treatment area patients using this form as a dashboard while tracking the condition of individual patients using Form 5b: Individual Treatment Record.
Page 10 of 34
Recommended kit: 5+/Team Kit
Filled out by:Medical Treatment Specialist
Turned in to:Team Scribe/Logistics
CERT or ICS Form equivalent: CERT Form 5
INSTRUCTIONS: NET FORM 5APATIENT TREATMENT AREA RECORD
1900 Building
Biddy Wopsle
Abel Magwitch
Havisham, Estella
Wemmick Heights 2015/08/29
12:48
13:02
13:18
16:30
16:45
16:30
002
11
Dick Charles Released
OHSU MCP
OHSU MCP
Small cut on left forearm. Bled, but superficial. Treated.
Left arm injury; possibly broken. Splinted.
Broken hand; lots of pain. Bandaged/splinted.
NET Form 5b: INDIVIDUAL TREATMENT RECORD
Name: Male FemaleAddress: Age:
Hair: Eyes:Clothing: Identifying Marks:
Symptoms/Chief Complaints:
Allergies (food, medicine, latex):
Medications (what?/last taken): Have Meds? No YesDiabetic? No YesHave Insulin? No Yes
Relevant Past Medical History:
Last Intake of Food and Fluids:
Narrative (what happened?):
Treatment Tracking: triage, initial treatment, treatment area, transport hospital, morgue
LocationDate
InTime
InInt. Date Out Time Out Int.
Category (I, D, M, X)
Time Objective Findings (physical exam and observation)
Time Treatment and Observations
The Individual Treatment Record is a specialized form intended to track the specific observations and treatments provided to an individual patient place in a patient treatment area. It is filled out by the volunteer(s) (CERT/NET or ATV/SUV) detailed to provide individual care. Completed treatment records should go with the individual when they move to a higher level of care, with a copy (physical or electronic) turned in to the NET’s Scribe.
The form is designed to be used by volunteers with basic medical training. It has two major purposes:
� The form serves as a guide to structure the initial examination of the patient and the gathering of relevant medical information.
� The form serves as a record of the findings discovered, the observations made, and the treatments provided by the volunteer medical personnel. This information is critical for medical personnel that may receive the patient later in the process.
Use as many pages as necessary to document findings.
It is a far, far better thing that I do
It is a far, far better rest that I go to than I
When completing the form, please use the following guidelines:
� Gather as much of the information as possible.
� Do not worry about using medical language. Write findings, observations and treatments in plain language.
� Make sure to document any relevant observations along with the time observed. Examples: intake of food or fluids, change in condition, increase in pain, appearance of bruising, etc.
Page 11 of 34
Recommended kit: 30+/Team Kit
Filled out by:Treatment Specialist
Turned in to: Team Scribe
CERT or ICS Form equivalent: None
INSTRUCTIONS: NET FORM 5BINDIVIDUAL TREATMENT RECORD
Looks exactly like Darnay
Sydney Carton
Neck was in wrong place at wrong time
Beer, one hour ago
X26
None
London14:25
Serious neck wound; will require stitches14:32
Late 18th century gentleman
XXX
None
None
NET
For
m 6
(ICS
309
): CO
MM
UN
ICAT
ION
S LO
G
MES
SAG
E A
ND
ACT
ION
LO
G (o
ne fo
r EA
CH R
AD
IO)
Task
nam
eFo
r ope
rati
onal
per
iod
#
Inci
dent
# a
nd n
ame
Dat
e st
arte
d
Tim
e st
arte
d
Ope
rato
r nam
e
Calls
ign
Tact
ical
ID
Radi
o/Ba
nd
TIM
E se
nt o
r re
ceiv
ed
FRO
M
calls
ign
of
send
ing
stat
ion
TO
calls
ign
of
rece
ivin
g st
atio
n
Act
ivit
y or
“Fro
m” a
nd “D
ate/
Tim
e” a
nd “S
ubje
ct” f
rom
G
ener
al M
essa
ge F
orm
8
PAG
E __
____
_ O
F __
____
_
The Communication Log tracks significant radio activity for each radio at a particular location. Logged activities should include:
� When the operator checks into or out of a net
� When the operator changes frequency
� When operator and logger changes with name and callsign of new person
� When the operator takes more than a 10 minute break
� Any significant event involving operation of this radio
� When the operator goes off the air.
HEA
DER
Inci
dent
# a
nd N
ame:
this
is a
ssig
ned
by
Inci
dent
Com
man
d.
Dat
e St
arte
d: u
se m
ilita
ry fo
rmat
(e.g
. 01
JAN
2014
). Ti
me
Star
ted:
the
time
you
arriv
ed o
n lo
catio
n or
beg
an o
pera
tions
; use
24
hour
cl
ock
and
loca
l tim
e.
Ope
rati
onal
Per
iod
#: n
umbe
red
sequ
entia
lly; o
p pe
riod
chan
ges w
hen
Team
Le
ader
cha
nges
. Ta
sk N
ame:
this
radi
o’s r
ole
in th
e re
spon
se
(e.g
. Com
man
d N
et, R
ed C
ross
Tact
ical
Net
). O
pera
tor N
ame
and
Call
sign
: nam
e/ca
ll si
gn o
f rad
io o
pera
tor a
t sta
rt o
f log
. Ta
ctic
al ID
: tac
tical
call
sign
of s
tatio
n,
assi
gned
by
TL.
Radi
o/Ba
nd: i
dent
ify th
e ra
dio
or b
and
mai
n fre
quen
cy.
LOG
GIN
G M
ESSA
GES
TI
ME
sent
/rec
: ent
er th
e tim
e th
e m
essa
ge is
sent
or r
ecei
ved;
use
24
hour
cl
ock
and
loca
l tim
e.
FRO
M: t
actic
al o
r sta
tion
call
sign
of
send
ing
stat
ion.
(Bla
nk fo
r act
ivity
.) TO
: tac
tical
or s
tatio
n ca
ll si
gn o
f re
ceiv
ing
stat
ion.
(Bla
nk fo
r act
ivity
.) N
arra
tive
: any
sign
ifica
nt a
ctiv
ity.
For a
Gen
eral
Mes
sage
: cal
lsig
n of
orig
inat
ing
stat
ion,
dat
e an
d tim
e m
essa
ge w
as a
utho
red
from
box
es
follo
win
g su
bjec
t on
the
Gen
eral
M
essa
ge fo
rm, a
nd e
xact
ly w
hat i
s in
the
“Sub
ject
” box
on
the
Gen
eral
M
essa
ge F
orm
.
Page 12 of 34
Recommended kit: 5+/ARO’s kit
Filled out by: ARO
Turned in to: Team Scribe
CERT or ICS Form equivalent: CERT Form 6
INSTRUCTIONS: NET FORM 6COMMUNICATIONS LOG
Abe
l M
agw
itch
, 29
Au
g2
016
, 14
:05
, pro
visi
ons
Gar
ger
y, J
oe
Joe
Gar
ger
y W
pe3
BA
B s
tart
s st
agin
g 1
du
ty
20
16/0
8/2
9
09
:00
36
Zom
bie
Att
ack
20
16
Sta
gin
g 1
GM
RS
Ch
ann
el 5
Wpe
3B
AB S
tag
ing
1R
over
A
14:2
5
Sta
gin
g a
rea
1 co
mm
and
net
15:1
0
Date (yyyy/mm/dd)
Neighborhood Emergency Team
NET Form 7: EQUIPMENT INVENTORY
Asset #Item
DescriptionOwner
Issued To
Assignment Tracking #
Qty Time Initials Comments
ISSUED
RETURNED
ISSUED
RETURNED
ISSUED
RETURNED
ISSUED
RETURNED
ISSUED
RETURNED
ISSUED
RETURNED
ISSUED
RETURNED
ISSUED
RETURNED
Logistics Officer
Page 13 of 34
Recommended kit: 5/Team Kit
Filled out by:Team Scribe/Logistics
Turned in to:Team Scribe/Logistics
CERT or ICS Form equivalent:CERT Form 7 (from ICS 303)
INSTRUCTIONS: NET FORM 7EQUIPMENT INVENTORY
If a team has a sizeable equipment cache, we recommend using this form to track team items as they are checked out and checked back in. This is particularly true of major assets, such as a SKED or radio set.
Consider delegating equipment responsibilities to a designated NET volunteer, or even an SUV. The forms should be kept with the equipment cache, and turned in to the Logistics section when completed.
Like tracking numbers, Asset Numbers are purely optional. If a team wishes to use asset numbers to help track tools and supplies, space is provided.
Gargery
Wemmick Heights
Barley
13:251001
002
Havisham
Wopsle14:25
001TEAM
TEAM
Wopsle
1
1
1
14:00
14:25
13:25
2FRS Radios
PrybarExtinguisher
Now empty.
BW
BW
BW
BW
A.B.
W002
W014
N/A
2015/08/29
NET Form 8: (ICS 213) GENERAL MESSAGE
TO POSITION
LOCATION
FROM POSITION
LOCATION
SUBJECT DATE TIME
MESSAGE
REPLY ON REVERSE SIDE
NET Form 8: (ICS 213) GENERAL MESSAGE
TO POSITION
LOCATION
FROM POSITION
LOCATION
SUBJECT DATE TIME
MESSAGE
REPLY ON REVERSE SIDE Page 14 of 34
Recommended kit: 3/personal kit
Filled out by: Any volunteeer
Turned in to: Recipient
CERT or ICS Form equivalent: CERT Form 8
INSTRUCTIONS: NET FORM 8GENERAL MESSAGE
General Message forms are used to send messages and responses via “runner” if radio communications are not available.
There are actually two forms per sheet, front and back. The sender writes a message on the front side, tears it in half, and gives it to a runner. The runner takes the paper to the receiver, and the receiver writes a response on the reverse side.
After the correspondence is completed, the message form should be turned in to Logistics and kept as part of the response record.
Biddy Wopsle
Abel Magwitch
Provisions
A seal has arrived and offered to help as an SUV, but only if we have sardines.
Does Logistics have any tinned sardines in the cache?
Logistics
ARO
2015/08/29 14:05
Irvington ES
Command
NET Form 1: DAMAGE ASSESSMENTNeighborhood Emergency Team Date (yyyy/mm/dd) Date/time received by TL
Person Reporting (please print) Person Receiving (please print)
SCRIBE ______________________________________________ PAGE _______ OF _______
Burn
ing
Out
Gas
Lea
k
H20
Lea
k
Elec
tric
Chem
ical
Dam
aged
*
Colla
psed
**
Inju
red
Trap
ped
Dec
ease
d
Road
A
cces
s?
Dan
gero
us
Ani
mal
s?
Location Fires Hazards Structures People # Y/N Y/N
* DAMAGED: Indicate Light (L), Medium (M) or Heavy (H) # PEOPLE: Indicate number of people** COLLAPSED: Indicate as Partial (P), Partial Front (PF), Partial Rear (PR) or Partial Side (PS)
NET Form 1: DAMAGE ASSESSMENT (reverse side)
Burn
ing
Out
Gas
Lea
k
H20
Lea
k
Elec
tric
Chem
ical
Dam
aged
*
Colla
psed
**
Inju
red
Trap
ped
Dec
ease
d
Road
A
cces
s?
Dan
gero
us
Ani
mal
s?
Location Fires Hazards Structures People # Y/N Y/N
* DAMAGED: Indicate Light (L), Medium (M) or Heavy (H) # PEOPLE: Indicate number of people** COLLAPSED: Indicate as Partial (P), Partial Front (PF), Partial Rear (PR) or Partial Side (PS)
SCRIBE ______________________________________________ PAGE _______ OF _______
NET
For
m 2
A: P
ERSO
NN
EL C
HEC
K IN
Nei
ghbo
rhoo
d Em
erge
ncy
Team
:D
ate
(yyy
y/m
m/d
d):
NA
ME
ID o
r bad
ge #
Cont
act
(cel
l or r
adio
)Ch
eck-
in
Tim
eA
ssig
nmen
t Tra
ckin
g N
umbe
rCh
eck-
out
Tim
e
SCRI
BE _
____
____
____
____
____
____
____
____
____
____
____
_
PA
GE
____
___
OF
____
___
Inco
min
g N
ET/C
ERT
volu
ntee
rs m
ust s
ign
in. D
esig
nate
whi
ch s
ectio
n an
d te
am th
ey w
ill re
port
to ("
Ass
ignm
ent"
). D
o no
t for
get t
o as
k th
em to
sig
n ou
t. Th
is m
ust b
e do
ne fo
r eve
ry s
hift
.U
se N
ET F
orm
3: S
UV
CHEC
K IN
for s
pont
aneo
us v
olun
teer
s.
NET
For
m 2
A: P
ERSO
NN
EL C
HEC
K IN
(rev
erse
sid
e)
NA
ME
ID o
r bad
ge #
Cont
act
(cel
l or r
adio
)Ch
eck-
in
Tim
eA
ssig
nmen
t Tr
acki
ng N
umbe
rCh
eck-
out
Tim
e
SCRI
BE _
____
____
____
____
____
____
____
____
____
____
____
_
PA
GE
____
___
OF
____
___
PRIN
T La
st, fi
rst n
ame:
___
____
____
____
____
____
____
____
____
Hav
e yo
u co
ntac
ted
your
fam
ily?
Yes
N
o
Wou
ld y
ou li
ke to
be
cont
acte
d in
the
futu
re fo
r vol
unte
er tr
aini
ng a
nd w
ork?
Ye
s
No
Wou
ld y
ou li
ke to
be
cont
acte
d ag
ain
to
help
with
this
em
erge
ncy?
Yes
N
o
I und
erst
and
the
dan
gers
of p
arti
cip
atin
g. D
esp
ite
the
pot
enti
al d
ange
rs a
nd r
isks
, I w
ill p
arti
cip
ate
and
I agr
ee t
o as
sum
e al
l the
ris
ks a
ssoc
iate
d w
ith
such
p
arti
cip
atio
n. In
con
sid
erat
ion
for
the
acce
pta
nce
of m
y p
arti
cip
atio
n as
a v
olun
teer
, I h
ereb
y w
aive
, re
leas
e, h
old
har
mle
ss, a
nd d
isch
arge
any
and
all
clai
ms
for
dam
ages
for
per
sona
l inj
ury,
pro
per
ty
dam
age
or d
eath
, whi
ch I
may
hav
e or
whi
ch m
ay
here
afte
r ac
crue
to
me,
or
to m
y he
irs
or a
ssig
ns,
as a
res
ult
of m
y p
arti
cip
atio
n as
a v
olun
teer
. In
add
itio
n, I
agre
e to
ind
emni
fy t
he C
ity
from
all
clai
ms
dem
and
s, s
uits
, act
ions
, lia
bili
ties
, dam
ages
, co
sts
or e
xpen
ses
resu
ltin
g fr
om o
r ar
isin
g ou
t of
m
y ac
tivi
ties
. Thi
s re
leas
e, w
aive
r of
liab
ility
and
in
dem
nity
agr
eem
ent
is in
tend
ed t
o d
isch
arge
and
re
leas
e th
e C
ity
of P
ortl
and,
and
its
agen
ts a
nd
emp
loye
es fr
om a
nd a
gain
st a
ny a
nd a
ll lia
bili
ty
aris
ing
out
of, o
r co
nnec
ted
in a
ny w
ay w
ith,
my
par
tici
pat
ion
as a
vol
unte
er. I
t is
furt
her
und
erst
ood
and
agr
eed
tha
t th
is r
elea
se, w
aive
r of
liab
ility
, and
in
dem
nity
agr
eem
ent
is t
o b
e b
ind
ing
on m
e an
d m
y he
irs
and
ass
igns
. I h
ave
care
fully
read
this
agr
eem
ent a
nd fu
lly
unde
rsta
nd it
s co
nten
t. I
am a
war
e th
at th
is is
a
rele
ase
of li
abili
ty a
nd a
con
trac
t bet
wee
n m
ysel
f an
d th
e Ci
ty o
f Por
tlan
d Bu
reau
of E
mer
genc
y M
anag
emen
t, a
nd I
sign
it v
olun
tari
ly a
nd o
f my
own
free
will
. I fu
rthe
rmor
e ce
rtify
that
all
info
rmat
ion
I pr
ovid
e is
true
and
cor
rect
.
Do
you
take
med
icat
ion
and
if so
, do
you
have
acc
ess
to it
?N
ot s
ure
Ye
s
No
N
/A
Agr
eem
ent o
f Und
erst
andi
ng
Plea
se id
enti
fy a
ny li
mit
atio
ns t
hat
wou
ld a
ffec
t th
e ty
pe o
f vol
unte
er
assi
gnm
ents
you
can
und
erta
ke.
____
____
____
____
____
____
____
____
____
____
____
____
____
__
____
____
____
____
____
____
____
____
____
____
____
____
____
__
____
____
____
____
____
____
____
____
____
____
____
____
____
__
____
____
____
____
____
____
____
____
____
____
____
____
____
__
____
____
____
____
____
____
____
____
____
____
____
____
____
__
To v
olun
teer
with
this
em
erge
ncy
resp
onse
, ple
ase
com
plet
e th
is fo
rm
and
retu
rn it
to th
e pe
rson
who
gav
e it
to y
ou. Y
ou w
ill re
ceiv
e a
brie
f in
terv
iew
as
soon
as
poss
ible
.
Plea
se a
nsw
er th
e qu
estio
ns tr
uthf
ully
and
as
com
plet
ely
as p
ossi
ble.
Thi
s in
form
atio
n he
lps
us fi
nd th
e m
ost a
ppro
pria
te a
ssig
nmen
t for
you
.D
ate
Sign
atur
e
NET
For
m 2
B: S
PON
TAN
EOU
S V
OLU
NTE
ER IN
TAKE
____
____
____
____
____
____
____
____
____
____
____
____
____
__
With
my
sign
atur
e be
low
, I c
ertif
y th
at I
have
not
bee
n co
nvic
ted
of a
felo
ny
sinc
e m
y 18
th b
irthd
ay.
sign
atur
e or
initi
als:
Age:
___
__
Equi
pmen
t/Su
pplie
s You
Can
Pro
vide
Firs
t aid
sup
plie
s ..
....
....
....
....
....
....
....
.Sp
are
whe
elch
air o
r cru
tche
s ...
....
....
....
....
Spar
e be
d(s)
...
....
....
....
....
....
....
....
....
Tarp
s or
tent
s ..
....
....
....
....
....
....
....
....
Chai
nsaw
....
....
....
....
....
....
....
....
....
..
Bott
led
wat
er .
....
....
....
....
....
....
....
....
.G
ener
ator
...
....
....
....
....
....
....
....
....
..
Fire
ext
ingu
ishe
r ...
....
....
....
....
....
....
....
Cam
p st
ove
and
fuel
...
....
....
....
....
....
....
Wal
kie-
talk
ie o
r oth
er ra
dio .
....
....
....
....
....
Pryb
ar .
....
....
....
....
....
....
....
....
....
....
Blan
ket(
s) ..
....
....
....
....
....
....
....
....
....
Flas
hlig
ht(s
) ...
....
....
....
....
....
....
....
....
.Ba
tter
ies .
....
....
....
....
....
....
....
....
....
..
Rope
...
....
....
....
....
....
....
....
....
....
...
Skill
s or
Exp
erie
nce
(mar
k al
l tha
t app
ly)
Med
ical
trai
ning
...
....
....
....
....
....
....
....
Firs
t aid
/CPR
...
....
....
....
....
....
....
....
....
Fire
figh
ting
skill
s ..
....
....
....
....
....
....
....
Safe
ty a
nd s
ecur
ity ..
....
....
....
....
....
....
...
Sear
ch a
nd re
scue
ski
lls .
....
....
....
....
....
...
Cris
is c
ouns
elin
g sk
ills .
....
....
....
....
....
....
.O
ffice
/org
aniz
atio
nal s
kills
...
....
....
....
....
..
Teac
hing
ski
lls .
....
....
....
....
....
....
....
....
Crow
d co
ntro
l ..
....
....
....
....
....
....
....
...
Carp
ente
r ski
lls .
....
....
....
....
....
....
....
...
Chai
nsaw
ski
lls ..
....
....
....
....
....
....
....
...
Elec
tric
ian
skill
s ...
....
....
....
....
....
....
....
.A
mat
eur r
adio
ski
lls .
....
....
....
....
....
....
...
Food
pre
p sk
ills
....
....
....
....
....
....
....
....
Com
mer
cial
lice
nse
....
....
....
....
....
....
....
non-
Engl
ish
lang
uage
s:FO
R O
FFIC
IAL
USE
ON
LY
ID v
erifi
ed (i
nitia
ls) _
____
___
Acc
epte
d?Ye
s
No
Issu
ed ID
?Ye
s
No
Ba
dge
# __
____
____
____
____
___
NET
org
aniz
atio
n/ob
ject
ives
...
....
....
....
....
....
....
Yes
N
o
Wea
pons
pol
icy
....
....
....
....
....
....
....
....
....
...
Yes
N
o
Safe
ty a
war
enes
s ...
....
....
....
....
....
....
....
....
...
Yes
N
o
Sear
ch a
nd re
scue
...
....
....
....
....
....
....
....
....
..Ye
s
No
Med
ical
tria
ge ..
....
....
....
....
....
....
....
....
....
...
Yes
N
o
Ass
ignm
ent 1
: ___
____
____
____
____
____
____
____
____
____
____
____
____
___
Ass
ignm
ent 2
: ___
____
____
____
____
____
____
____
____
____
____
____
____
___
Wai
ver s
igne
d ..
....
....
....
....
....
....
....
....
....
...
Yes
N
o
Whi
te: O
pera
tions
Man
ager
Yello
w: P
lann
ing
Pink
: Vol
unte
er L
ead
Hom
e ad
dres
s: _
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
City
: ___
____
____
____
____
____
____
Stat
e: _
____
_Zi
p co
de: _
____
____
____
_
E-m
ail:
____
____
____
____
____
____
____
____
Driv
er’s
licen
se (s
tate
/#):
____
____
____
____
____
__G
ende
r: __
____
Last
, firs
t nam
e: _
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
Best
pho
ne: (
____
_) _
____
- __
____
__
Yes
Fi
t for
phy
sica
l wor
k?N
o
Ligh
t
Emer
genc
y co
ntac
t nam
e: _
____
____
____
____
____
_Re
latio
n: _
____
____
____
____
____
Emer
genc
y co
ntac
t pho
ne: (
____
_) _
____
- __
____
__
NET
For
m 2
B: S
PON
TAN
EOU
S V
OLU
NTE
ER IN
TAKE
(rev
erse
)
NET
For
m 3
: TEA
M L
EAD
ER’S
ASS
IGN
MEN
T TR
ACK
ING
LO
G
Nei
ghbo
rhoo
d Em
erge
ncy
Team
D
ate
(yyy
y/m
m/d
d)
Ass
ignm
ent
Ass
ignm
ent
Trac
king
#Tr
acki
ng #
Loca
tion
Loca
tion
Team
Team
Team
Lea
der
Team
Lea
der
Star
t Tim
eEn
d Ti
me
Star
t Tim
eEn
d Ti
me
VO
LUN
TEER
S A
SSIG
NED
VO
LUN
TEER
S A
SSIG
NED
1.)
1.)
2.)
2.)
3.)
3.)
4.)
4.)
5.)
5.)
Obj
ecti
ves
Obj
ecti
ves
Resu
lts
Resu
lts
NET
LEA
DER
:SC
RIBE
:PA
GE
___
____
_ O
F __
____
__
NET
For
m 3
: TEA
M L
EAD
ER’S
ASS
IGN
MEN
T TR
ACK
ING
LO
G (r
ever
se s
ide)
Nei
ghbo
rhoo
d Em
erge
ncy
Team
D
ate
(yyy
y/m
m/d
d)
Ass
ignm
ent
Ass
ignm
ent
Trac
king
#Tr
acki
ng #
Loca
tion
Loca
tion
Team
Team
Team
Lea
der
Team
Lea
der
Star
t Tim
eEn
d Ti
me
Star
t Tim
eEn
d Ti
me
VO
LUN
TEER
S A
SSIG
NED
VO
LUN
TEER
S A
SSIG
NED
1.)
1.)
2.)
2.)
3.)
3.)
4.)
4.)
5.)
5.)
Obj
ecti
ves
Obj
ecti
ves
Resu
lts
Resu
lts
NET
LEA
DER
:SC
RIBE
:PA
GE
___
____
_ O
F __
____
__
Neighborhood Emergency Team
Date (yyyy/mm/dd)
NET Form 4: ASSIGNMENT BRIEFING
Team Tactical Call Sign
Assignment Tracking Number
Time Out
Time Back
Cmnd. Post Contact ph. # or Radio Channel
Cmnd. Post Contact Name
Mission Location
INSTRUCTIONS TO TEAM
SCRIBE
Mission Objectives
FILL OUT MISSION RESULTS ON REVERSE SIDE
Equipment Allocated
NET Form 4: ASSIGNMENT BRIEFING (reverse side)
SCRIBE
MISSION RESULTS
Mission Narrative/Details
Tracking #Bu
rnin
g
Out
Gas
Lea
k
H20
Lea
k
Elec
tric
Chem
ical
Dam
aged
*
Colla
psed
**
Inju
red
Trap
ped
Dec
ease
d
Road
A
cces
s?
Dan
gero
us
Ani
mal
s?
Location Fires Hazards Structures People # Y/N Y/N
* DAMAGED: Indicate Light (L), Medium (M) or Heavy (H) # PEOPLE: Indicate number of people** COLLAPSED: Indicate as Partial (P), Partial Front (PF), Partial Rear (PR) or Partil Side (PS)
Indicate any volunteers injured during mission here
NET
For
m 5
a: V
ICTI
M T
REAT
MEN
T A
REA
REC
ORD
Nei
ghbo
rhoo
d Em
erge
ncy
Team
D
ate
(yyy
y/m
m/d
d)
Trea
tmen
t Are
a Lo
cati
onTr
acki
ng N
umbe
r
Chec
k-in
Ti
me
Nam
e or
Des
crip
tion
Tria
ge T
ag
(cir
cle
one)
Cond
itio
n/Tr
eatm
ent
(upd
ate
as n
eede
d)M
oved
To
Chec
k-O
ut
Tim
e
SCRI
BE _
____
____
____
____
____
____
____
____
____
____
____
_
PA
GE
____
___
OF
____
___
IMM
ED
DEL
AY
MIN
OR
IMM
ED
DEL
AY
MIN
OR
IMM
ED
DEL
AY
MIN
OR
IMM
ED
DEL
AY
MIN
OR
IMM
ED
DEL
AY
MIN
OR
NET
For
m 5
a: V
ICTI
M T
REAT
MEN
T A
REA
REC
ORD
(rev
erse
sid
e)
Chec
k-in
Ti
me
Nam
e or
Des
crip
tion
Tria
ge T
ag
(cir
cle
one)
Cond
itio
n/Tr
eatm
ent
(upd
ate
as n
eede
d)M
oved
To
Chec
k-O
ut
Tim
e
SCRI
BE _
____
____
____
____
____
____
____
____
____
____
____
_
PA
GE
____
___
OF
____
___
IMM
ED
DEL
AY
MIN
OR
IMM
ED
DEL
AY
MIN
OR
IMM
ED
DEL
AY
MIN
OR
IMM
ED
DEL
AY
MIN
OR
IMM
ED
DEL
AY
MIN
OR
IMM
ED
DEL
AY
MIN
OR
NET
For
m 5
b: IN
DIV
IDU
AL
TREA
TMEN
T RE
CORD
Nam
e:
M
ale
Fem
ale
Addr
ess:
Age:
Hai
r:Ey
es:
Clot
hing
:Id
entif
ying
Mar
ks:
Sym
ptom
s/Ch
ief C
ompl
aint
s:
Alle
rgie
s (fo
od, m
edic
ine,
late
x):
Med
icat
ions
(wha
t?/la
st ta
ken)
:H
ave
Med
s?
No
Yes
Dia
betic
?
N
o
Y
esH
ave
Insu
lin?
No
Yes
Rele
vant
Pas
t Med
ical
His
tory
:
Last
Inta
ke o
f Foo
d an
d Fl
uids
:
Nar
rativ
e (w
hat h
appe
ned?
):
Trea
tmen
t Tra
ckin
g:
tria
ge, i
nitia
l tre
atm
ent,
trea
tmen
t are
a, tr
ansp
ort h
ospi
tal,
mor
gue
Loca
tion
Dat
e In
Tim
e In
Int.
Dat
e O
utTi
me
Out
Int.
Cate
gory
(I,
D, M
, X)
Tim
eO
bjec
tive
Fin
ding
s (p
hysi
cal e
xam
and
ob
serv
atio
n)
Tim
eTr
eatm
ent a
nd O
bser
vati
ons
Additional Notes
NET Form 5b: INDIVIDUAL TREATMENT RECORD (reverse side)
Vital SignsNORMS 60-100 12-16 Warm/dry/pink Alert
Time Pulse Resp. Skin AVPU
NOTE: AVPU stands for Aler tVoicePainUnresp onsive
NET Form 6 (ICS 309): COMMUNICATIONS LOG
MESSAGE AND ACTION LOG (one for EACH RADIO)
Task nameFor operational period #
Incident # and name
Date started
Time started
Operator name
Callsign
Tactical ID
Radio/Band
TIME sent or
received
FROM callsign of
sending station
TO callsign of receiving
station
Activity OR “From” and “Date/Time” and “Subject” from General Message Form 8
PAGE _______ OF _______
NET Form 6 (ICS 309): COMMUNICATIONS LOG (reverse side)
MESSAGE AND ACTION LOG (one for EACH RADIO)
TIME sent or
received
FROM callsign of
sending station
TO callsign of receiving
station
Activity OR “From” and “Date/Time” and “Subject” from General Message Form 8
PAGE _______ OF _______
Dat
e
(yyy
y/m
m/d
d)N
eigh
borh
ood
Emer
genc
y Te
am
NET
For
m 7
: EQ
UIP
MEN
T IN
VEN
TORY
Ass
et #
Item
D
escr
ipti
onO
wne
rIs
sued
To
Ass
ignm
ent
Trac
king
#Q
tyTi
me
Init
ials
Com
men
ts
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
Logi
stic
s O
ffice
r
NET
For
m 7
: EQ
UIP
MEN
T IN
VEN
TORY
(rev
erse
sid
e)
Nei
ghbo
rhoo
d Em
erge
ncy
Team
Dat
e
(yyy
y/m
m/d
d)
Ass
et #
Item
D
escr
ipti
onO
wne
rIs
sued
To
Ass
ignm
ent
Trac
king
#Q
tyTi
me
Init
ials
Com
men
ts
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
ISSU
ED
RETU
RNED
Logi
stic
s O
ffice
r
NET
For
m 8
: (IC
S 21
3) G
ENER
AL
MES
SAG
E
TOPO
SITI
ON
LOCA
TIO
N
FRO
MPO
SITI
ON
LOCA
TIO
N
SUBJ
ECT
DAT
ETI
ME
MES
SAG
E
REPL
Y O
N R
EVER
SE S
IDE
NET
For
m 8
: (IC
S 21
3) G
ENER
AL
MES
SAG
E
TOPO
SITI
ON
LOCA
TIO
N
FRO
MPO
SITI
ON
LOCA
TIO
N
SUBJ
ECT
DAT
ETI
ME
MES
SAG
E
REPL
Y O
N R
EVER
SE S
IDE
GEN
ERA
L M
ESSA
GE
REPL
Y
TOPO
SITI
ON
LOCA
TIO
N
FRO
MPO
SITI
ON
LOCA
TIO
N
SUBJ
ECT
DAT
ETI
ME
MES
SAG
E RE
PLY
GEN
ERA
L M
ESSA
GE
REPL
Y
TOPO
SITI
ON
LOCA
TIO
N
FRO
MPO
SITI
ON
LOCA
TIO
N
SUBJ
ECT
DAT
ETI
ME
MES
SAG
E RE
PLY
