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HICS Forms

Overview

HICS Forms

July 9, 2013
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HICS COVID Templates for Incident Action Planning

March 9, 2020

These templates are intended to serve only as samples for those new to HICSi:

HICS 201: Incident Briefing

HICS 202: Incident Objectives Examples

HICS 204: Assignment List Finance

HICS 214: Activity Log

HICS 2015A: Incident Action Plan IAP Safety Analysis

HICS 2015A: Incident Action Plan IAP Safety Analysis

Infection Disease Incident Planning Guide (IPG)

Infection Disease Incident Response Guide (IRG)

Hospital Seasonal influenza/Pandemic Preparedness Checklist

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HICS Fifth Edition Released

June 6, 2015

The California Emergency Medical Services Authority (EMSA) is pleased to announce the public release of the Fifth Edition of the Hospital Incident Command System (HICSi). This conclusion of the multi-year revision process is the culmination of extensive national stakeholder input. The California EMSA wishes to thank all participants in this endeavor that exemplifies unprecedented collaboration among both public and private healthcare and emergency management partners from communities across the local, regional, state, and national levels. This HICS, Fifth Edition is offered to assist hospitals and the healthcare community nationwide with their emergency management goals.

Special recognition is given to a multitude of individuals and groups for their invaluable contributions. This includes Ex Officio members from the following organizations: the American Hospital Association (AHA); The Joint Commission; the U.S. Department of Veterans’ Affairs, Veterans’ Health Administration, Office of Emergency Management; the U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response (ASPR), National Healthcare Preparedness Programs; the U.S. Department of Homeland Security, Federal Emergency Management Agency, National Integration Center; and the American Society for Healthcare Engineering (ASHE).

The California EMSA also extends special gratitude to Kaiser Permanente and MedStar Washington Hospital Center, the HICS Final Review Group, the HICS 2011 National Summit Stakeholders, the HICS National Workgroup and the HICS Secondary Review Group

  • Access HICS Fifth Edition
  • HICS Forms
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HICS Forms: Completed Examples

December 2, 2014

HICS 201 Incident Briefing

HICS 202 Incident Objectives

HICS 203 Organization Assignment List

HICS 204 Assignment List

HICS 205A Communications List

HICS 206 Staff Medical Plan

HICS 207 Hospital Incident Management Team (HIMT) Chart

HICS 213 General Message Form

HICS 214 Activity Log

HICS 215A Incident Action Plan (IAP) Safety Analysis

HICS 221 Demobilization Check-Out

HICS 251 Facility System Status Report

HICS 252 Section Personnel Time Sheet

HICS 253 Volunteer Registration

HICS 254 Disaster Victim/Patient Tracking

HICS 255 Master Patient Evacuation Tracking

HICS 256 Procurement Summary Report

HICS 257 Resource Accounting Record

HICS 258 Hospital Resource Directory

HICS 259 Hospital Casualty/Fatality Report

HICS 260 Patient Evacuation Tracking

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HICS Role Table Tents

November 6, 2008
  1. The HICSi Role Table Tents can be used during actual events or for exercises. They identify the name of each person filling the top nine roles.
  2. The tent cards act as a reminder of the Incident Action Planning Process and assist with completion of the appropriate forms.
  3. When it comes to completing The Joint Commission table top survey, TJC states that they want name plates/table tents with the role and name of person in the table top. This will also provide those personnel with a reminder on the role of that position and the Incident Action Planning Process.
  • HICS Role Table Tents (color version)
  • HICS Role Tabel Tents (black and white version)
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HICS

  • HICS Courses
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  • Incident Response Guide / Incident Planning Guide
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