Incident Status Summary (ICS 209) *1. Incident Name: 2. Incident Number: *3. Report Version (check *4. Incident Commander(s) & 5. Incident *6. Incident Start Date/Time: one box on left): Agency or Organization: Management Date: Organization: Initial Rpt # Time: (if used): Update Time Zone: Final 7. Current Incident Size 8. Percent (%) *9. Incident 10. Incident *11. For Time Period: (use unit or Area Involved Contained Definition: Complexity From Date/Time: label Level: – e.g., “sq mi,” “city _____________ block”): Completed To Date/Time: _____________ Approval & Routing Information *12. Prepared By: *13. Date/Time Submitted: Print Name: ICS Position: Time Zone: Date/Time Prepared: *14. Approved By: *15. Primary Location, Organization, or Agency Sent To: Print Name: ICS Position: Signature: Incident Location Information *16. State: *17. County/Parish/Borough: *18. City: 19. Unit or Other: *20. Incident Jurisdiction: 21. Incident Location Ownership (if different than jurisdiction): 22. Longitude (indicate format): 23. US National Grid Reference: 24. Legal Description (township, section, range): Latitude (indicate format): *25. Short Location or Area Description (list all affected areas or a reference point): 26. UTM Coordinates: 27. Note any electronic geospatial data included or attached (indicate data format, content, and collection time information and labels): Incident Summary *28. Significant Events for the Time Period Reported (summarize significant progress made, evacuations, incident growth, etc.): 29. Primary Materials or Hazards Involved (hazardous chemicals, fuel types, infectious agents, radiation, etc.): 30. Damage Assessment Information (summarize A. Structural B. # Threatened C. # D. # damage and/or restriction of use or availability to Summary (72 hrs) Damaged Destroyed residential or commercial property, natural resources, E. Single Residences critical infrastructure and key resources, etc.): F. Nonresidential Commercial Property Other Minor Structures Other ICS 209, Page 1 of ___ * Required when applicable.
Incident Status Summary (ICS 209) *1. Incident Name: 2. Incident Number: *3. Report Version (check one box on left): *4. Incident Commander(s) & Agency or Organization: 5. Incident Management Organization: *6. Incident Start Date/Time: Date: Time: Time Zone: Initial Update Final Rpt # (if used): 7. Current Incident Size or Area Involved (use unit label – e.g., “sq mi,” “city block”): 8. Percent (%) Contained _____________ Completed _____________ *9. Incident Definition: 10. Incident Complexity Level: *11. For Time Period: From Date/Time: To Date/Time: Approval & Routing Information *12. Prepared By: Print Name: ICS Position: Date/Time Prepared: *13. Date/Time Submitted: Time Zone: *14. Approved By: Print Name: ICS Position: Signature: *15. Primary Location, Organization, or Agency Sent To: Incident Location Information *16. State: *17. County/Parish/Borough: *18. City: 19. Unit or Other: *20. Incident Jurisdiction: 21. Incident Location Ownership (if different than jurisdiction): 22. Longitude (indicate format): Latitude (indicate format): 23. US National Grid Reference: 24. Legal Description (township, section, range): *25. Short Location or Area Description (list all affected areas or a reference point): 26. UTM Coordinates: 27. Note any electronic geospatial data included or attached (indicate data format, content, and collection time information and labels): Incident Summary *28. Significant Events for the Time Period Reported (summarize significant progress made, evacuations, incident growth, etc.): 29. Primary Materials or Hazards Involved (hazardous chemicals, fuel types, infectious agents, radiation, etc.): 30. Damage Assessment Information (summarize damage and/or restriction of use or availability to residential or commercial property, natural resources, critical infrastructure and key resources, etc.): A. Structural Summary B. # Threatened (72 hrs) C. # Damaged D. # Destroyed E. Single Residences F. Nonresidential Commercial Property Other Minor Structures Other ICS 209, Page 1 of ___ * Required when applicable.
ics209.docx