Attachment C: Alternate Care Site Evacuation Routes and Center Plans <Insert evacuation routes, floor plans, maps, and written directions to evacuation sites> Attachment D: Sample Hospital Incident Command System (HICS) Forms HICS forms are provided by the District Planner. HICS 203 Organization Assignment List – HICS 207 Hospital Incident Management Team Chart – HICS 254 Disaster Victim/Patient Tracking – HICS 255 Master Patient Evacuation Tracking – HICS 257 Resource Accounting Record – HICS 260 Patient Evacuation Tracking Form – Attachment E: Affiliated Facilities Specific Information This attachment should include the following location specific information: Table 2: Exercises Conducted 3: Individuals Responsible for Emergency Operations Plan Activation Table 4: Roles and Responsibilities 6: Delegations of Authority List of Top Five Hazards from Center Hazard Vulnerability Analysis Center Plan Table 15: External Contacts Attachment 2: 1: Employee Emergency Call Back Roster Attachment 2: 6: Critical Infrastructure Contact Information
Attachment C: Alternate Care Site Evacuation Routes and Center Plans <Insert evacuation routes, floor plans, maps, and written directions to evacuation sites> Attachment D: Sample Hospital Incident Command System (HICS) Forms HICS forms are provided by the District Planner. HICS 203 – Organization Assignment List HICS 207 – Hospital Incident Management Team Chart HICS 254 – Disaster Victim/Patient Tracking HICS 255 – Master Patient Evacuation Tracking HICS 257 – Resource Accounting Record HICS 260 – Patient Evacuation Tracking Form Attachment E: Affiliated Facilities Specific Information This attachment should include the following location specific information: Table 2: Exercises Conducted 3: Individuals Responsible for Emergency Operations Plan Activation Table 4: Roles and Responsibilities 6: Delegations of Authority List of Top Five Hazards from Center Hazard Vulnerability Analysis Center Plan Table 15: External Contacts Attachment 2: 1: Employee Emergency Call Back Roster Attachment 2: 6: Critical Infrastructure Contact Information
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