Standard Operating Guidelines Manual54.172.27.91/EM/ACIST/Western New York IMT... · Standard...

Standard Operating Guidelines Manual

2015

Consists of the following Counties: Allegany, Cattaraugus,

Chautauqua, Erie, Genesee, Livingston, Monroe, Niagara, Orleans,

and Wyoming

Approved April 13, 2015

List of Revisions

Revision Reason Date

Spring 2015 – Approved items will be addressed when board is picked – 2/2015

Fall 2015 – Changed UASI Advisor to UASI/SHSP Advisor as neither county receives UASI

funds anymore – 11/2015

Western New York IMT

(New York State Regional – Type 3 IMT)

Policies and Procedures 2014

Cover

List of Revisions

I. Introduction

Purpose

Scope

Mission Statement

II. Leadership & Team Administration

Leadership

Executive Committee

Executive Committee Positions

Team Administration

Equal Opportunities & Non-Discrimination

Meetings & Elections

Team Composition (Structure)

Team Selection

Team Membership

Uniform & Appearance

Conduct & Disciplinary Actions

Team Equipment

Equipment Deployments

Radio Equipment

Equipment Deployment & Mutual Aid Requests

Equipment Storage

Equipment Lost or Stolen

Equipment Inventory

Team Ready Bag

III. Operating Concepts

Daily Operations

Duty Officer

Deployment Operations

Team Notification

Team Mobilization & Notification

Deployment Orders

Deployments

Incident Management

After Action Reporting

Hot Wash

After Action Report

Negative Feedback

IV. Team Health and Safety Team Health & Safety

Work & Rest Standards

Driving Regulations

Injury Reporting

Appendices

Team Application

Executive Position Job Descriptions

Suspension Form

Written Warning/ Disciplinary Form

Team Equipment Inventory

Ready Bag List –Personal

Mobilization Form (Personnel Orders)

ICS Form 226 — Individual Performance Rating

WNY Medical History Form

WNY IMT Injury Report Form

Executive Committee By-Laws

I. Introduction

Purpose

The purpose of this document is to establish administrative policies that will be used for

conducting both the day-to-day operations as well as disaster operations for the Western New York

Incident Management Team (WNY IMT).

Scope

The scope of this document is designed to encompass policies and procedural actions that occur in

both day-to-day operations as well as disaster operations.

Mission Statement

The Western New York All Hazards Incident Management Team (WNY IMT) is composed of

public safety professionals who provide support and assistance to augment ongoing operations, or

when requested by the authorized jurisdiction, transition activities to an incident management

function, including components/functions of Command and General Staff. The WNY IMT shall

also be capable of providing Emergency Operations Center support as requested. These goals will

be achieved through training, exercises and deployments in order to provide efficient, professional

incident management assistance to state, local and regional authorities.

II. Leadership & Team Administration

Leadership

Executive Committee

It is the primary purpose of the Executive Committee to provide oversight to the Incident

Management Team: develop policies, position certification qualifications, oversight of training

and deployment protocols; team and individual evaluation/performance review processes;

individual/agency fiscal reimbursement expenditure constraints; and protocol for intra-state

mobilizations, in accordance with WNY IMT policies, Article 2B of the New York State Executive

Law, established policies of the New York State IMT Program Chief, and any other applicable

state law, rule or regulation.

The Executive Committee shall consist of all ten (10) County Emergency Managers and/or

designee. Those counties are: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Livingston,

Monroe, Niagara, Orleans and Wyoming. The remainder of the positions on the Executive

Committee will be as follows: Administrative Officer, Finance Officer, Training Officer and

UASI/SHSP Advisor. These positions, with the exception of the UASI/SHSP Advisor, are to be

elected by the general membership every two (2) years based on team and NYS strategic

initiatives. The Executive Committee shall be governed by bylaws established by the executive

committee.

All members in good standing are eligible to run for any of the three (3) Executive Committee

positions. With the exception of the Chair and Vice Chair, those two positions will be voted on by

the County Emergency Managers. The UASI/SHSP Advisor position will alternate annually

between the Rochester/Monroe UAWG and the Buffalo/Erie/Niagara UAWG. Elections will be

held in March.

Team Administration

Equal Opportunity & Non-Discrimination

It is the firm policy of WNY IMT that every person involved with training, exercising, activation,

or deployment of the Team in any way shall be free of any type of harassment or discrimination for

any reason, including, but not limited to, that person's race, national origin, religion, age, gender

(sex), gender identity, or sexual orientation. The WNY IMT policy is "zero tolerance" for any such

harassment or discrimination.

In the case of a disability covered under the Americans With Disabilities Act, the knowledge and

skill prerequisites, identified by the Department of Homeland Security, US Fire Administration,

National Fire Academy, the National Incident Management System Integration Center (NIC), and

the National Credentialing System are considered to be the Essential Job Functions that apply to

the team positions identified in this document. Team Leaders will permit and encourage full

participation of persons with disabilities by making reasonable accommodations where such

accommodations allow a team member to perform these Essential Job Functions and fully meet

training course and/or exercise objectives without placing other team members in danger of injury

or death.

Meetings and Elections

All meeting notices and agendas will be published on the WNY IMT Dropbox and emailed to team

members no less than 14 days prior to the meeting date. Meeting minutes will be published no

more than 30 days following any meeting by the team Administrative Officer on the WNY IMT

Dropbox and emailed out to team members.

All WNYIMT meetings and elections will be conducted in the manner proscribed by Roberts Rules

of Order (2011, 11th Edition).

Team Composition (Structure)

The WNY IMT operates on a command structure built within the team. An individual’s title or

rank outside the team will not have any influence on their position or the teams operation. To

operate the WNY IMT effectively, command and general staff positions with some Unit Leader

positions will be filled. Each position should be staffed two (2) to three (3) deep, for a total of 75

members. If necessary, the team may exceed 75 members in order to function more efficiently.

During a deployment, each member will report to their direct supervisor (Section Chief or Unit

Leader), pushing information through the command structure to its final destination. The

information will be responded to and answers sent back through the command structure. At no time

shall a team member go around a supervisor or outside the team’s structure without direction from

his/her Section Chief.

AT NO TIME shall team members go to another agency regarding WNY IMT information without

the knowledge of the Executive Committee.

Western New York Incident Management Team Executive Committee & Team Leadership Structure

Team Selection

It is understood and agreed that all individuals serving on the WNY IMT do so as volunteers, with

no expectation of compensation for service on the IMT except as may be due to them under Article

2B of the New York State Executive Law and the Robert T. Stafford Disaster Recovery Act, or by

agreement with their employer. Team members may be sponsored by their respective public

service (local municipality, tribal nation, or state agency).

Applicants shall complete an application (Appendix 1), including all supporting documentation

(i.e., certificates, resume, etc.). The application package will be signed by the County Emergency

Manager and then forwarded to the WNY IMT Administrative Officer (AO). The applicant will be

voted on by the Executive Committee. The Administrative Officer will then notify the applicant of

the decision.

Executive Committee -10 Emergency

Managers

Administrative Officer

2-3 Member SubCommittee

Training Officer


Finance Officer


UASI/SHSP Advisor -Buffalo/Erie/Niagara

UASI/SHSP or Monroe UASI/SHSP

Team ICS Structure

Command Staff

General Staff

Members shall be selected as WNY IMT team members based on the following criteria:

1. Length, depth and scope of emergency service experience, including:

• Command, Command Staff, and General Staff experience;

• Type and scale of incidents they have participated in;

• Formal education in incident management or emergency management of disasters and

major emergencies; and

• Formal training and certification in incident command & management;

2. Education, training and experience unrelated to emergency management that may be relevant to

the applicant’s desired position on the team or that may benefit the team as a whole. All

applications will be reviewed by the Executive Committee to determine if the individual meets the

initial qualifications set by the Executive Committee.

The WNY IMT Executive Committee is responsible for…

• Selecting trainees based on the needs of the WNY IMT.

• Making available the necessary training.

• Providing opportunities for evaluation of the trainee’s skills and abilities.

• Determining position certification.

• Issuing proof of certification.

• Issuing Position Task Books (PTB) to document task performance. The training officer

will develop a sub-committee to develop an SOP for these task books.

• Explaining to the trainee the purpose and processes of the PTB

Team Membership

There are two levels of team membership, Probationary Member and Regular Member.

Probationary Member:

• The individual has met the minimum requirements outlined in WNY IMT policies

and approved by the Executive Committee.

• Shall serve a mandatory twelve-month probationary period from the date appointed.

• Remains a member in good-standing

• Is not eligible to be assigned to the positions of Command Staff during

deployments.

• Is not eligible to be assigned to the position of Section or Deputy Section Chief

during deployments.

• Is not eligible to be assigned to the position of Administration Officer, Training

Officer or Finance Officer.

During the probationary period, the Executive Committee reserves the right to revoke probationary

status at any time by a majority vote of the committee. On the twelfth month anniversary, the

probationary member will automatically become a regular member of the team unless otherwise

informed by the Executive Committee.

Regular Member:

• A member that has completed probationary period

• Remains as a member in good-standing

Member in Good Standing

To be considered a member in good standing:

• Attend 50% of scheduled team meetings annually.

• Attend 50% of scheduled team training annually.

External training Authorized in advanced by the Team Commander or Training Officer will be

accepted up-to 25% of team training for that year.

• Adheres to State and WNY IMT policies/procedures

• Remains active in team deployments

• Maintains a professional working relationship with team members.

The Executive committee will continuously review each member’s activity. If a member is found

to be deficient, the Executive Committee will take action to correct the deficiencies. The Executive

Committee’s corrective actions range from verbal warning to termination of membership. If a

member is not available to attend 50% of team meetings or training during a six-month period, the

member shall provide the team’s Administrative Officer with written documentation outlining their

reason. The Executive Committee will review the reason and excuse the member on a case-by-case

basis.

Uniform and Appearance

During deployments or team training combined with other agencies, WNY IMT members will

dress in the approved WNY IMT uniform. It is understood that team member’s may respond from

their place of employment or other personal commitments without an approved uniform. Team

members will be expected to report to their next scheduled operation period in the approved team

uniform.

WNY IMT does not issue team uniforms. It is understood that the team members will purchase

their own uniform compliant with team policies. In the future should WNY IMT begin to purchase

and issue uniforms, reimbursement will not be offered for previously purchased uniforms.

The following is the approved WNY-IMT team uniform:

• Navy Blue Polo Style S/S shirt with team logo over left breast. Navy Blue 5.11

style or equivalent L/S shirt and/or jacket with team logo over left breast.

• 5.11 style or equivalent khaki long pants

• Navy Blue BDUs with Team Logo

• Socks showing must be black or navy

• Navy Blue Job Shirt with Team Logo

• Footgear, adequate for providing protection in adverse condition and

environments.

• Or if your agency requires you to wear your agency department uniform that is

acceptable however, your IMT credentials MUST visible at all times.

Team members will be issued picture identification. This identification remains the property of

WNY IMT and is to be used for official team business only. In the event of misuse, the

identification will be revoked and the Executive Committee will take corrective action. Team

Members will display their identification at all times during a team deployment or training

combine with any other agency. Upon separation from WNY IMT, the member will return their

picture identification to the team’s Administrative Officer.

Conduct & Disciplinary Actions

All WNY IMT team members shall conduct themselves in a safe, efficient and professional

manner at all times when they are representing the team. All WNY IMT members while deployed

agree to obey all WNY IMT policies and procedures outlined in this document. Failure to do so

may result in disciplinary action or removal from the team.

Alcohol, illegal or intoxicating prescription drugs shall not be permitted at any incident scene,

training, exercise site, or event location. Team members who report to an incident scene, event

location, a training or exercise site while under the influence of alcohol or illegal drugs shall be

relieved of their duties by the on-duty Team Commander or Safety Officer.

No team member will self-deploy or freelance at any time. A member desiring to attend a function

or incident other than a WNY IMT deployment, in his or her capacity as a member of WNY IMT,

must obtain permission from the Team Commander or Deputy Team Commander to attend. If

permission is granted, team activation steps must be followed.

Disciplinary action during any and all WNY IMT events, all complaints and request for

disciplinary action will be immediately forwarded to the on-duty Commander. The on-duty

Commander will evaluate the request and decide what level of action is appropriate, such as: verbal

warning, written warning, or suspension from the team.

If the on-duty Commander finds the offense serious in nature, s/he may immediately suspend the

member and remove them from duty. Within 48 hours following the deployment, the involved

Commander will file a complete written report (Appendix 2) with the Executive Committee

requesting a suspension hearing. The Executive Committee will notify the team member that a

complaint was filed against them. The team member shall then have 24 hours to file a response

with the Executive Committee. The Executive Committee will have 48 hours to review the incident

and file its findings with the team’s Administrative Officer. The Executive Committee has the

option, based on the information provided, of upholding the suspension or, deciding on a lower

level of discipline. (Appendix 3)

If the on-duty Commander finds the offense to be terminable, the Commander will immediately

suspend the member and remove him/her from duty. Within 48 hours following the deployment,

the involved Commander will file a complete report of the incident and a request for termination

with the Executive Committee. The Executive Committee will notify the team member that a

complaint was filed against them. The team member shall then have 24 hours to file a response

with the Executive Committee. The Executive Committee will have 48 hours to review the incident

and file its findings with the team’s Administrative Officer. The Executive Committee has the

option, based on the information provided, of upholding the termination request or, deciding on a

lower level of discipline.

Team Equipment

Equipment Deployment

WNY IMT functions with equipment provided through the member counties, the

Monroe/Rochester UAWG, Buffalo/Erie/Niagara UAWG, and local governmental agencies. The

Counties (Erie, Monroe and Cattaraugus) that have the WNY IMT equipment is to ensure that

those Counties will make arrangements for the equipment to be delivered to the location where the

IMT is to function. All WNY IMT equipment will be efficiently marked as such so there is no

confusion when on deployment. Appendix 4 – Equipment Inventory List

• Maintain and upkeep of Equipment boxes is the responsibility of that county

who has the box. (Monroe County, Erie County, Cattaraugus County).

Radio Equipment

Equipment will be deployed if needed per incident. At all times, during radio transmissions, the

utilization of plain language is required and shall be adhered to.

Equipment damaged lost or stolen on deployment

When any WNY IMT equipment is damaged, lost or stolen, it shall be reported to the Logistics

Section Chief immediately upon being noticed and the proper equipment form shall be completed.

If the equipment is damaged, an “out of service” tag shall be placed on the equipment identifying

the problem and the name/phone number of the team member taking the equipment out of service.

The Logistics Section Chief will notify Team Commander and Finance Section Chief of the

damage.

DISCLAIMER: At no time is the WNY IMT responsible for personal or departmental damaged or

lost equipment.

Equipment Inventory

All WNY IMT equipment will be inventoried, labeled with WNY IMT identifiers, and recorded

and maintained by the county responsible for the equipment.

Team Ready Bag

Each member should have a ready bag that would be able to self-sustain that member for a period

of 48 hours. See Appendix 5

III. Operating Concepts

Daily Operations

Duty Officer

The Chair, Vice Chair and Administrative Officer will assume the position of Duty Officer for two

(2) years making themselves available via phone contact by the Department of Homeland Security

and Emergency Services (DHSES) Region V, the NYS Watch Center and the NYS IMT Program

Manager.

The WNY IMT Duty Officer will notify DHSES Region V of the request for deployment. The

deployment should be considered a local/regional emergency management mutual aid response

unless Article 2B activation has been requested, and approved by DHSES. Regional IMTs are not

covered under Article 2B unless activated by DHSES. The Duty Officer, as soon as practical, will

supply DHSES Region 5 with the deployment forms and complete team roster. DHSES Region 5

will notify the Director of the New York State Office of Emergency Management (OEM) or State

Duty Officer, and Commissioner of DHSES of the team’s deployment, or request for activation.

The WNY IMT Duty Officer will first activate, or request the activation of, the First Level

Deployment to start a rapid response and obtain the team objectives. Once this information is

gathered and a full team deployment is warranted, the First Level Deployment will respond, or

request activation of a full team response.

The WNY IMT Duty Officer may bypass the First Level Deployment for a full-team activation

based on the information received from the DHSES or county/local emergency manager. Team

members will respond to the instructions given during the notification process.

Deployment Operations

Team Deployments

All deployments under the DHSES, NYS OEM, must meet the requirements of Article 2B. When

major emergencies or a disaster is imminent or, is occurring within DHSES Region 5, the State or

when a county emergency manager requests the assistance, the WNY IMT Duty Officer will be

notified, with follow up notifications to the DHSES/NYS OEM Region V.

The local Authority Having Jurisdiction (AHJ) will define the WNY IMT’s role:

• The WNY IMT may provide a support role for the local Incident Command System

structure.

• In the event the AHJ requests the WNY IMT to manage the incident they will provide a

Delegation of Authority to the IMT and if appropriate, Unified Command will be used.

Team Mobilization & Notification

WNY IMT will be activated via DisasterLan notification and messaging system through phone

numbers provided by team members. No remuneration will be offered to team members for

receiving text and email messages regarding team notifications.

In addition to the DisasterLan notification, email notification should be provided to all team

members.

First Level Deployment

The WNY IMT Duty Officer may first activate the First Level Deployment to start a rapid

response and obtain the team objectives and operating instructions. Once this information is

gathered and a full team deployment is warranted, the First Level Deployment will activate a full

team response. The WNY IMT Duty Officer may bypass the First Level Deployment for a full

team activation based on the information received by DHSES Region 5 Duty Officer or other

mechanisms noted previously.

First Level Deployment consists of Incident Commander, Deputy Incident Commander, Liaison

Officer, & Operations Section Chief.

Deployment Orders

Deployment orders for all deploying team members will be initiated by the Chair, Vice Chair and

Administrative Officer and completed by the Team Commander accompanying the deploying

personnel. All deployment orders should be completed using the WNY IMT Mobilization Form

(Appendix 6).

Deployments

Personal Accountability –

Check-in is required of all personnel. All WNY IMT personnel upon arrival will report to their

Section Chief to check-in. If they are not present, or un-available, then the team member will

check-in with the on-duty team commander.

Incident Management

The incident will be managed using the established guidelines and operating principals of the

Incident Command System. The incident management will be consistent with team members

existing NIM/ICS training.

Demobilization

The IMT will be demobilized according to the process that is outlined within the Demobilization

Plan that is created by the Incident Planning Section and approved by the Incident Commander.

The WNY IMT is not completely demobilized until all IMT resources have returned to their home

jurisdictions.

NO WNY IMT member is to self-demobilize without notification and approval by the Team

Commander.

Performance Evaluation

Prior to demobilization, the WNY IMT Incident Commander should discuss overall Team

Performance with the Authority Having Jurisdiction (AHJ). This discussion provides an

opportunity to cover important aspects of team performance, such as:

• Accomplishment of Agency goals and objectives,

• Effective incident management,

• Team leadership and professionalism,

• Sensitivity to local concerns, resource limits, environmental, political and social concerns,

and costs,

• Recognition of changing conditions and effective use of local resources, and

• Proper emphasis on safety and initiating action.

In addition, each supervisor should evaluate the performance of all team members using ICS Form

226 — Individual Performance Rating (Appendix 7). Each team member and their supervisor will

sign the rating form at the conclusion of the rating discussion. A separate form is completed for

each IMT position held. Section Chiefs should review all appraisals for team members in their

section. The Incident Commander will review and countersign all ratings where the overall rating

is outstanding or unsatisfactory. Each team member should be given a copy of their appraisal at the

end of their assignment.

Copies of the completed evaluation forms are forwarded to the WNY IMT Training Officer for

inclusion in Team records/files.

After Action Reporting

Hot Wash

The IMT should conduct a “Hot Wash” style debriefing as soon as possible after the IMT has

returned from an incident. The debriefing should be structured and allow for each section to

critique its performance and the entire teams performance. All information during the session

should be captured for inclusion into the After Action Report.

After Action Report

The IMT shall complete an After Action Report (AAR) after every activation to ensure that there

are written records of the teams activities and for use in tracking any improvement items that may

result from debriefing after incidents. It is the responsibility of the Administrative Officer to ensure

that the AAR is completed and submitted to the Incident Commander/Executive Committee no

later than 3 weeks after the IMT debrief.

The formal AAR should conform to established guidelines and include:

• Executive Summary

• Summary of events

• Areas of Strength & Areas of Improvement

• Lessons Learned & Observed Best Practices

• Improvement Plan

Negative Feedback

Complaints regarding the performance of the WNY IMT during an incident will be directed to the

Requesting Agency. The Requesting Agency will conduct an inquiry into the complaint. Upon

completion of the inquiry the Requesting Agency will determine if the complaint is substantiated

or unfounded. If the complaint is substantiated, then the Requesting Agency will recommend

appropriate corrective action to the WNY IMT Incident Commander to improve the team’s

performance.

Complaints regarding an individual member’s performance will be directed to the WNY IMT

Incident Commander. The WNY IMT Incident Commander will conduct an inquiry into the

complaint. Upon completion of the inquiry the WNY IMT Incident Commander will determine if

the complaint is sustained or unfounded. If the complaint is sustained, then the WNY IMT Incident

Commander will recommend appropriate corrective action to improve the team member’s

performance.

IV. Team Health & Safety

Health and Safety

The Incident Commander is responsible for monitoring and assessing hazardous and unsafe

situations and developing measures for assuring personnel safety. The Incident Commander will

correct unsafe acts or conditions through the regular line of authority, although the IC must

exercise emergency authority to stop or prevent unsafe acts when immediate action is required.

Although every individual has safety responsibilities, the Incident Commander has the indirect

responsibility to ensure that the incident is handled in a safe manner.

Work and Rest Standards

The WNY IMT is committed to a safe work environment. To ensure that all team members are safe

at an incident and in transit to and from the event, the following guidelines have been adopted:

Plan for and ensure that all personnel are provided a minimum 2:1 work to rest ratio (for every 2

hours of work or travel, provide 1 hour of sleep and/or rest).

Work shifts that exceed 16 hours and/or consecutive days that do not meet the 2:1 work/rest ratio

should be the exception, and no work shift should exceed 24 hours. However, in situations where

this does occur (for example, initial attack), incident management personnel will resume a 2:1

work/rest ratio as quickly as possible.

The Incident Commander or Agency Administrator must justify work shifts that exceed 16 hours

and those that do not meet 2:1 work to rest ratio. Justification will be documented in the daily

incident records. Documentation shall include mitigation measures used to reduce fatigue.

Driving Regulations

In addition to individual agency policy, the WNY IMT uses the following additional guidelines:

1. To manage fatigue, every effort should be made to conduct mobilization and demobilization

travel between 0500 hours and 2200 hours.

2. Fatigue counter measures beyond those required by this policy should be employed when

conditions require them. These may include but are not limited to:

a. Providing additional drivers operating within the appropriate duty-day limitations.

b. Reducing duty-day limitations.

c. Expanded rest requirements.

d. Alternate travel methods.

3. Non-CDL: For non-Commercial Driving License (CDL) driving, current national interagency 2-

to-1 work/rest policy applies. Duty-day will NOT exceed 16 hours.

Exception: Exceptions to work-rest and duty-day limitations in this category are allowed ONLY

IF in response to initial attack, AND where essential to 1) accomplish immediate and critical

response objectives, or 2) address immediate and critical public safety issues, and ONLY IF prior

approval is granted and documented by the Agency Administrator responsible for the incident.

Mobilization, other than for initial attack, and demobilization are neither immediate nor critical

activities.

4. CDL: All driving requiring CDL will be performed in accordance with applicable Department of

Transportation regulations found in 49 CFR 383 and 390-397.

a. No driver of a vehicle requiring a CDL will drive the vehicle after 15 hours on duty

during any duty-day.

b. Exception: An additional 2 hours of driving time may be added if: a driver encounters

adverse driving conditions, unforeseen emergency situations (breakdown), or to ensure the

safety of personnel.

Drivers are responsible to follow these policies and it is the supervisor’s responsibility to ensure

that employees adhere to the proper driving limitations and monitor employee fatigue

Injury Reporting

Any injury suffered while on active service with the WNY IMT will be immediately reported to

the individual’s direct supervisor and the incident safety officer. The supervisor will complete the

WNY IMT Injury Report Form (Appendix 8) in duplicate and deliver the completed form to the

Incident Commander and the Admin/Finance Section Chief. A copy of this report at the time of

the Incident should go to the Safety Officer and a copy of the report should also go to the team

member’s responsible agency.

Appendixes

Team Application – Appendix 1

Suspension Form – Appendix 2 – Needs to be completed

Written Warning/Disciplinary Form – Appendix 3 – Needs to be completed

Team Equipment Inventory Sample – Appendix 4

Ready Bag List –Personal – Appendix 5

Mobilization Form (Personnel Orders) – Appendix 6 – Needs to be completed

ICS Form 226 — Individual Performance Rating – Appendix 7

WNY IMT Medical History Form – Appendix 8

WNY IMT Injury Report Form - Appendix 9

Executive Committee By-Laws – In Progress

Executive Committee Job Descriptions – Needs to be completed

IMT Position(s) Qualified For:

Personal Information

Name:

Public Safety Agency/Organization:

Job Title/Rank:

Phone Number: Cell Number:

Fax Number:

E-Mail:

Nominee’s Supervisor Information

Employer:

Employer Supervisor Name: Phone Number:

Agency Endorsement:

I endorse the above named nominee for participation on the Western New York IMT. The

agency/organization is fully prepared to support this commitment within the limits of our

agency/organization’s operational capacity. We understand there will be a time

commitment required for participation in training, exercises, and incident deployments. (NOTE: Your signature represents your approval to allow the employee to be deployed. It is up to the employee to notify you

when they are being deployed).

Signature:______________________________________________Date:_____________

Print Name:____________________________________ Title:_____________________

Experience –

Attach a resume & complete the real world experience section on the following page.

Deployment Capabilities

Please check all boxes that apply.

I can deploy for 3–5 days. I can deploy for 4–7 days.

I can deploy continuously. I can deploy within the region.

I can deploy within the state. I can deploy within the country.

Please list any ICS training and other training specific to the position(s) for which

you are applying (use continuation form or provide attachment if necessary):

Note: ICS 300 Certificate – Unit Leader Position ICS 400 Certificate – Section Chief Position

Acknowledgement of Commitment I acknowledge that selection to the Western New York IMT will require a commitment of time for

participation in training, exercises, and incident deployment and am fully prepared to honor this

commitment.

Signature of Applicant Date

Signature of County Emergency Manager:

Nomination Form for ICS Position on

Western New York IMT

Type 3 IMT

Western District Emergency Management Assistance Team

REAL WORLD EXPERIENCE

Please provide us with a brief narrative of your real world experience as it relates to the positional

structure of the Incident Management Team.

Appendix 2 – Suspension Form – Needs to be completed

Written Warning/ Disciplinary Form – Appendix 3 – Needs to be completed

Please Note: All Personal Items are your individual responsibility; the team is not liable if something happens to your items while on deployment.

Suggestions for IMT Personal GO KITS

-Team ID

-Copies of your important documents in a plastic Ziploc bag. (Ie. Passport, driver’s

license, health insurance card, family/friend contact information, note of what

you are allergic to and what medications you are taking, why and the dosage)

-Cash ($50-$100 in small denominations), Credit Cards

-Bottled water and nonperishable food. (Ie. Energy and/or granola bars)

-One flashlight and extra batteries (LED if possible)

-Extra eyeglasses

-Sleeping Bags, Pillows, Blankets, Cots

-Small first aid kit (band aids, antibacterial soap, sun screen, bug spray,

Neosporin)

-Clothes for 5-7 days (also uniforms WNY IMT shirt and Khakis, weather driven

clothing ie. Winter gear as well as non-uniform clothes for after hours)

-Sunscreen

-Sunglasses

-Hearing protection

-Head gear - Helmet

-Swiss army knife

-Sharpies

-Feminine hygiene items

-Bathroom items (shampoo, conditioners, tooth brush, tooth paste, soap, towels,

flip flops, etc.)

DRAFT

Please Note: All Personal Items are your individual responsibility; the team is not liable if something happens to your items while on deployment.

-Deck of cards

-Whistle (So you can be found)

-Cell phone chargers

-Computer/IPad & chargers

-FOG

-ICS forms and other documents/supplies you will need for your section

Western New York Incident Management Team Spring 2014

Policy & Procedure Manual DRAFT

29

Mobilization Form (Personnel Orders) – Appendix 6 – Needs to be completed



30



31

Western New York IMT Medical History Form

Personal Information Last Name

Middle Name

First Name

Gender

Home address

Home Telephone

Date of Birth (MM/DD/YYYY)

Medical Information Doctor’s name

Address

Telephone number

Blood type

Current Medical Conditions

Past Medical Conditions

Allergies

Current Medications

Emergency Information Emergency Contact Name

Relationship

Address

Telephone number(s)

NOTE: The information contained on this document is confidential medical and personal information. It will be placed in a sealed envelope with your name only on the outside. It will be opened only in the event that you require medical attention arising out of and during the course of your participation in the WNY IMT activation and the sealed envelop will be opened only by emergency medical services personnel or hospital Emergency Room personnel. At the conclusion of the activation, this information, if not used, with be returned in the envelope, unopened. By signing below, you are agreeing to this disclosure of this information for the stated purpose. _____________________________________________ Signature _____________ Date



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WNY-IMT Report of Injury Form

Name of Injured Person: Gender: ❑ Male ❑ Female

Organization: Injured Persons Phone #:

Supervisor’s Name: (Please Print)

Title:

Has the Safety Officer been contacted? ❑ Yes ❑ No If NO please contact immediately

Date of injury: Time of injury:

Names of witnesses (if any):

Location of Injury:

Describe How Injury Occurred:

What parts of the body were injured?

Part of body affected: (shade all that apply)

Nature of injury:

❑ Abrasion, scrapes

❑ Amputation

❑ Breathing Difficulties

❑ Bruise

❑ Burn (heat)

❑ Burn (chemical)

❑ Concussion (to the head)

❑ Cut/Laceration

❑ Crush

❑ Death

❑ Dislocation

❑ Fracture

❑ Heart Attack

❑ Hernia

❑ Puncture

❑ Sprain, strain

❑ Stroke

❑ Damage to a body system:

❑ Other ______________________

_____________________________

Environmental Conditions:

❑ Rain

❑ Heat: Temperature:_______

❑ Cold: Temperature:_______

❑ Snow/Ice

❑ Terrain

❑ Wind

❑ Fog

❑ Other:___________________

__________________________

Exposure:

❑ Fumes

❑ Chemicals

Type if Known _____________

__________________________

❑ Communicable Disease

❑ Radioactive

❑ Other:___________________

__________________________

Type of Treatment: ❑ Onsite Medical ❑ Hospital

Onsite Medical Treatment Performed By:_________________________________________________________

Name & Address of Hospital:__________________________________________________________________

Personal Protective Equipment Worn: ❑ Hard hat

❑ Gloves

❑ Safety Shoes

❑ Shoes/Sneakers/Boots

❑ Respirator: Type:_______________

❑ Safety Glasses/Goggles

❑ Other:________________________

_______________________________

Name of Person Filling Out This Form: Date:

Title:

Signature: Time:

Safety Officer’s Name: Date:

Signature: Time:



33

Executive Committee By-Laws – In Progress



34

Executive Committee Job Positions – Needs to be completed

Chair Position: (Give Job Description)

Liaison with the State

Vice Chair Position: (Give Job Description)

In absence of Chair – Liaison with the State

Administrative Officer: (Give Job Description)

Will be in charge of:

Maintain all records of meeting agenda and minutes

Credentialing

Safety and Medical documents/policies

Team policies/guidelines/procedures

Maintain Contact Information of team members

Third level contact with the State if Chair and Vice Chair are unavailable

Consist of 2-3 team members assigned to officer to assist with these matters.

Finance Officer: (Give Job Description)


Team Vendor ID numbers – develop and maintain spreadsheet for team members

Develop and create policies for reimbursement documents/packets for team

members when deployed

Work with Medical to develop compensation claim form

Maintain Contracts/MOUs for team


Training Officer: (Give Job Description)


Maintaining training and exercise calendar

Maintaining training records of team members forward it on to the Administrative

Officer for their files once a year.

Maintaining records of the qualified positions team members are eligible for


UASI/SHSP Advisor: (Give Job Description)

Standard Operating Guidelines Manual54.172.27.91/EM/ACIST/Western New York IMT... · Standard...

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Transcript of Standard Operating Guidelines Manual54.172.27.91/EM/ACIST/Western New York IMT... · Standard...