Fillable DEMOBILIZATION CHECK-OUT (ICS 221) (FEMA)

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DEMOBILIZATION CHECK-OUT (ICS 221) (FEMA)

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The DEMOBILIZATION CHECK-OUT (ICS 221) (FEMA) form is 1 page long and contains:

  • 15 signatures
  • 20 check-boxes
  • 56 other fields

Country of origin: US
File type: PDF

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DEMOBILIZATION CHECK-OUT (ICS 221)
1. Incident Name: 2. Incident Number:
3. Planned Release Date/Time:
Date: Time:
4. Resource or Personnel Released:
5. Order Request Number:
6. Resource or Personnel:
You and your resources are in the process of being released. Resources are not released until the checked boxes
below have been signed off by the appropriate overhead and the Demobilization Unit Leader (or Planning Section
representative).
LOGISTICS SECTION
Unit/Manager
Remarks
Supply Unit
Communications Unit
Facilities Unit
Ground Support Unit
Security Manager
FINANCE/ADMINISTRATION SECTION
Unit/Leader
Remarks
Time Unit
OTHER SECTION/STAFF
Unit/Other
Remarks
PLANNING SECTION
Unit/Leader
Remarks
Documentation Leader
Demobilization Leader
7. Remarks:
8. Travel Information:
Room Overnight: Yes No
Estimated Time of Departure: Actual Release Date/Time:
Destination: Estimated Time of Arrival:
Travel Method: Contact Information While Traveling:
Manifest: Yes No
Number:
Area/Agency/Region Notified:
9. Reassignment Information:
Yes No
Incident Name:
Incident Number:
Location:
Order Request Number:
10. Prepared by: Name: Position/Title: Signature:
ICS 221
Date/Time:
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ICS 221
Demobilization Check-Out
Purpose. The Demobilization Check-Out (ICS 221) ensures that resources checking out of the incident have completed
all appropriate incident business, and provides the Planning Section information on resources released from the incident.
Demobilization is a planned process and this form assists with that planning.
Preparation. The ICS 221 is initiated by the Planning Section, or a Demobilization Unit Leader if designated. The
Demobilization Unit Leader completes the top portion of the form and checks the appropriate boxes in Block 6 that may
need attention after the Resources Unit Leader has given written notification that the resource is no longer needed. The
individual resource will have the appropriate overhead personnel sign off on any checked box(es) in Block 6 prior to
release from the incident.
Distribution. After completion, the ICS 221 is returned to the Demobilization Unit Leader or the Planning Section. All
completed original forms must be given to the Documentation Unit. Personnel may request to retain a copy of the ICS 221.
Notes:
• Members are not released until form is complete when all of the items checked in Block 6 have been signed off.
• If additional pages are needed for any form page, use a blank ICS 221 and repaginate as needed.
Block
Number
Block Title Instructions
1
Incident Name
Enter the name assigned to the incident.
2
Incident Number
Enter the number assigned to the incident.
3 Planned Release Date/Time
Enter the date (month/day/year) and time (using the 24-hour clock) of
the planned release from the incident.
4 Resource or Personnel
Released
Enter name of the individual or resource being released.
5 Order Request Number
Enter order request number (or agency demobilization number) of the
individual or resource being released.
6 Resource or Personnel
You and your resources are in
the process of being released.
Resources are not released until
the checked boxes below have
been signed off by the
appropriate overhead and the
Demobilization Unit Leader (or
Planning Section
representative).
• Unit/Leader/Manager/Other
• Remarks
• Name
• Signature
Resources are not released until the checked boxes below have been
signed off by the appropriate overhead. Blank boxes are provided for
any additional unit requirements as needed (e.g., Safety Officer,
Agency Representative, etc.).
Logistics Section
Supply Unit
Communications Unit
Facilities Unit
Ground Support Unit
Security Manager
The Demobilization Unit Leader will enter an "X" in the box to the left of
those Units requiring the resource to check out.
Identified Unit Leaders or other overhead are to sign the appropriate
line to indicate release.
Block
Number
Block Title Instructions
6
(continued)
Finance/Administration
Section
Time Unit
The Demobilization Unit Leader will enter an "X" in the box to the left of
those Units requiring the resource to check out.
Identified Unit Leaders or other overhead are to sign the appropriate line
to indicate release.
Other Section/Staff
The Demobilization Unit Leader will enter an "X" in the box to the left of
those Units requiring the resource to check out.
Identified Unit Leaders or other overhead are to sign the appropriate line
to indicate release.
Planning Section
Documentation Leader
Demobilization Leader
The Demobilization Unit Leader will enter an "X" in the box to the left of
those Units requiring the resource to check out.
Identified Unit Leaders or other overhead are to sign the appropriate line
to indicate release.
7 Remarks
Enter any additional information pertaining to demobilization or release
(e.g., transportation needed, destination, etc.). This section may also be
used to indicate if a performance rating has been completed as required
by the discipline or jurisdiction.
8
Travel Information
Enter the following travel information:
Room Overnight Use this section to enter whether or not the resource or personnel will be
staying in a hotel overnight prior to returning home base and/or unit.
Estimated Time of Departure Use this section to enter the resource’s or personnel’s estimated time of
departure (using the 24-hour clock).
Actual Release Date/Time Use this section to enter the resource’s or personnel’s actual release date
(month/day/year) and time (using the 24-hour clock).
Destination Use this section to enter the resource’s or personnel’s destination.
Estimated Time of Arrival Use this section to enter the resource’s or personnel’s estimated time of
arrival (using the 24-hour clock) at the destination.
Travel Method Use this section to enter the resource’s or personnel’s travel method (e.g.,
POV, air, etc.).
Contact Information While
Traveling
Use this section to enter the resource’s or personnel’s contact information
while traveling (e.g., cell phone, radio frequency, etc.).
Manifest Yes No
Number
Use this section to enter whether or not the resource or personnel has a
manifest. If they do, indicate the manifest number.
Area/Agency/Region Notified Use this section to enter the area, agency, and/or region that was notified
of the resource’s travel. List the name (first initial and last name) of the
individual notified and the date (month/day/year) he or she was notified.
9 Reassignment Information
Yes No
Enter whether or not the resource or personnel was reassigned to another
incident. If the resource or personnel was reassigned, complete the
section below.
Incident Name Use this section to enter the name of the new incident to which the
resource was reassigned.
Incident Number Use this section to enter the number of the new incident to which the
resource was reassigned.
Location
Use this section to enter the location (city and State) of the new incident to
which the resource was reassigned.
Order Request Number
Use this section to enter the new order request number assigned to the
resource or personnel.
Block
Number
Block Title Instructions
10 Prepared by
• Name
• Position/Title
• Signature
• Date/Time
Enter the name, ICS position, and signature of the person preparing the
form. Enter date (month/day/year) and time prepared (using the 24-hour
clock).
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Completed 7 June 2022

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