Fill - Free fillable Nims Ics Forms Booklet (v3) (FEMA) PDF form

National Incident Management

System Incident Command

System

September 2010

ICS Forms

ATIONAL INCIDENT MANAGEMENT SYSTEM

INCIDENT COMMAND SYSTEM

ICS FORMS BOOKLET

FEMA 502-2

September 2010

INTRODUCTION TO ICS FORMS

The National Incident Management System (NIMS) Incident Command System (ICS) Forms Booklet, FEMA 502-2, is

designed to assist emergency response personnel in the use of ICS and corresponding documentation during incident

operations. This booklet is a companion document to the NIMS ICS Field Operations Guide (FOG), FEMA 502-1, which

provides general guidance to emergency responders on implementing ICS. This booklet is meant to complement existing

incident management programs and does not replace relevant emergency operations plans, laws, and ordinances. These

forms are designed for use within the Incident Command System, and are not targeted for use in Area Command or in

multiagency coordination systems.

These forms are intended for use as tools for the creation of Incident Action Plans (IAPs), for other incident management

activities, and for support and documentation of ICS activities. Personnel using the forms should have a basic

understanding of NIMS, including ICS, through training and/or experience to ensure they can effectively use and

understand these forms. These ICS Forms represent an all-hazards approach and update to previously used ICS Forms.

While the layout and specific blocks may have been updated, the functionality of the forms remains the same. It is

recommended that all users familiarize themselves with the updated forms and instructions.

A general description of each ICS Form’s purpose, suggested preparation, and distribution are included immediately after

the form, including block-by-block completion instructions to ensure maximum clarity on specifics, or for those personnel

who may be unfamiliar with the forms.

The ICS organizational charts contained in these forms are examples of how an ICS organization is typically developed

for incident response. However, the flexibility and scalability of ICS allow modifications, as needed, based on experience

and particular incident requirements.

These forms are designed to include the essential data elements for the ICS process they address. The use of these

standardized ICS Forms is encouraged to promote consistency in the management and documentation of incidents in the

spirit of NIMS, and to facilitate effective use of mutual aid. In many cases, additional pages can be added to the existing

ICS Forms when needed, and several forms are set up with this specific provision. The section after the ICS Forms List

provides details on adding appendixes or fields to the forms for jurisdiction- or discipline-specific needs.

It may be appropriate to compile and maintain other NIMS-related forms with these ICS Forms, such as resource

management and/or ordering forms that are used to support incidents. Examples of these include the following

Emergency Management Assistance Compact (EMAC) forms: REQ-A (Interstate Mutual Aid Request), Reimbursement

Form R-1 (Interstate Reimbursement Form), and Reimbursement Form R-2 (Intrastate Reimbursement Form).

ICS FORMS LIST

This table lists all of the ICS Forms included in this publication.

Notes:

• In the following table, the ICS Forms identified with an asterisk (*) are typically included in an IAP.

• Forms identified with two asterisks (**) are additional forms that could be used in the IAP.

• The other ICS Forms are used in the ICS process for incident management activities, but are not typically included in

the IAP.

• The date and time entered in the form blocks should be determined by the Incident Command or Unified Command.

Local time is typically used.

ICS Form #:

Form Title:

Typically Prepared by:

ICS 201

Incident Briefing

Initial Incident Commander

*ICS 202

Incident Objectives

Planning Section Chief

*ICS 203

Organization Assignment List

Resources Unit Leader

*ICS 204 Assignment List

Resources Unit Leader and Operations Section

Chief

*ICS 205 Incident Radio Communications Plan

Communications Unit Leader

**ICS 205A Communications List

Communications Unit Leader

*ICS 206 Medical Plan

Medical Unit Leader (reviewed by Safety Officer)

ICS 207 Incident Organization Chart

(wall-mount size, optional 8½″ x 14″)

Resources Unit Leader

**ICS 208

Safety Message/Plan

Safety Officer

ICS 209

Incident Status Summary

Situation Unit Leader

ICS 210

Resource Status Change

Communications Unit Leader

ICS 211 Incident Check-In List

(optional 8½″ x 14″ and 11″ x 17″)

Resources Unit/Check-In Recorder

ICS 213 General Message (3-part form)

Any Message Originator

ICS 214 Activity Log (optional 2-sided form)

All Sections and Units

ICS 215 Operational Planning Worksheet

(optional 8½″ x 14″ and 11″ x 17″)

Operations Section Chief

ICS 215A

Incident Action Plan Safety Analysis

Safety Officer

ICS 218 Support Vehicle/Equipment Inventory

(optional 8½″ x 14″ and 11″ x 17″)

Ground Support Unit

ICS 219-1 to ICS

219-8, ICS 219-10

(Cards)

Resource Status Card (T-Card)

(may be printed on cardstock)

Resources Unit

ICS 220 Air Operations Summary Worksheet

Operations Section Chief or Air Branch Director

ICS 221 Demobilization Check-Out

Demobilization Unit Leader

ICS 225 Incident Personnel Performance

Rating

Supervisor at the incident

ICS FORM ADAPTION, EXTENSION, AND APPENDIXES

The ICS Forms in this booklet are designed to serve all-hazards, cross-discipline needs for incident management across

the Nation. These forms include the essential data elements for the ICS process they address, and create a foundation

within ICS for complex incident management activities. However, the flexibility and scalability of NIMS should allow for

needs outside this foundation, so the following are possible mechanisms to add to, extend, or adapt ICS Forms when

needed.

Because the goal of NIMS is to have a consistent nationwide approach to incident management, jurisdictions and

disciplines are encouraged to use the ICS Forms as they are presented here – unless these forms do not meet an

organization’s particular incident management needs for some unique reason. If changes are needed, the focus on

essential information elements should remain, and as such the spirit and intent of particular fields or “information

elements” on the ICS Forms should remain intact to maintain consistency if the forms are altered. Modifications should be

clearly indicated as deviations from or additions to the ICS Forms. The following approaches may be used to meet any

unique needs.

ICS Form Adaptation

When agencies and organizations require specialized forms or information for particular kinds of incidents, events, or

disciplines, it may be beneficial to utilize the essential data elements from a particular ICS Form to create a more localized

or field-specific form. When this occurs, organizations are encouraged to use the relevant essential data elements and

ICS Form number, but to clarify that the altered form is a specific organizational adaptation of the form. For example, an

altered form should clearly indicate in the title that it has been changed to meet a specific need, such as “ICS 215A,

Hazard Risk Analysis Worksheet, Adapted for Story County Hazmat Program.”

Extending ICS Form Fields

Particular fields on an ICS Form may need to include further breakouts or additional related elements. If such additions

are needed, the form itself should be clearly labeled as an adapted form (see above), and the additional sub-field

numbers should be clearly labeled as unique to the adapted form. Letters or other indicators may be used to label the

new sub-fields (if the block does not already include sub-fields).

Examples of possible field additions are shown below for the ICS 209:

• Block 2: Incident Number.

• Block 2A (adapted): Full agency accounting cost charge number for primary authority having jurisdiction.

• Block 29: Primary Materials or Hazards Involved (hazardous chemicals, fuel types, infectious agents, radiation, etc.).

• Block 29A (adapted): Indicate specific wildland fire fuel model number.

Creating ICS Form Appendixes

Certain ICS Forms may require appendixes to include additional information elements needed by a particular jurisdiction

or discipline. When an appendix is needed for a given form, it is expected that the jurisdiction or discipline will determine

standardized fields for such an appendix and make the form available as needed.

Any ICS Form appendixes should be clearly labeled with the form name and an indicator that it is a discipline- or

jurisdiction-specific appendix. Appendix field numbering should begin following the last identified block in the

corresponding ICS Form.

INCIDENT BRIEFING (ICS 201)

1. Incident Name: 2. Incident Number: 3. Date/Time Initiated:

Date: Time:

4. Map/Sketch (include sketch, showing the total area of operations, the incident site/area, impacted and threatened

areas, overflight results, trajectories, impacted shorelines, or other graphics depicting situational status and resource

assignment):

5. Situation Summary and Health and Safety Briefing (for briefings or transfer of command): Recognize potential

incident Health and Safety Hazards and develop necessary measures (remove hazard, provide personal protective

equipment, warn people of the hazard) to protect responders from those hazards.

6. Prepared by: Name: Position/Title: Signature:

ICS 201, Page 1

Date/Time:

click to sign

signature

click to edit

INCIDENT BRIEFING (ICS 201)

1. Incident Name:

2. Incident Number:

3. Date/Time Initiated:

Date: Time:

7. Current and Planned Objectives:

8. Current and Planned Actions, Strategies, and Tactics:

Time: Actions:

6. Prepared by: Name: Position/Title: Signature:

ICS 201, Page 2

Date/Time:

click to sign

signature

click to edit

INCIDENT BRIEFING (ICS 201)

1. Incident Name: 2. Incident Number: 3. Date/Time Initiated:

Date: Time:

9. Current Organization (fill in additional organization as appropriate):

6. Prepared by: Name: Position/Title: Signature:

ICS 201, Page 3

Date/Time:

Incident Commander(s)

Planning

Section Chief

Operations S

ection Chief

Finance/Admin Section Chief

Logistics Section Chief

Safety Officer

Public Information Officer

Liaison Officer

click to sign

signature

click to edit

ICS 201

Incident Briefing

Purpose. The Incident Briefing (ICS 201) provides the Incident Commander (and the Command and General Staffs) with

basic information regarding the incident situation and the resources allocated to the incident. In addition to a briefing

document, the ICS 201 also serves as an initial action worksheet. It serves as a permanent record of the initial response

to the incident.

Preparation. The briefing form is prepared by the Incident Commander for presentation to the incoming Incident

Commander along with a more detailed oral briefing.

Distribution. Ideally, the ICS 201 is duplicated and distributed before the initial briefing of the Command and General

Staffs or other responders as appropriate. The “Map/Sketch” and “Current and Planned Actions, Strategies, and Tactics”

sections (pages 1–2) of the briefing form are given to the Situation Unit, while the “Current Organization” and “Resource

Summary” sections (pages 3–4) are given to the Resources Unit.

Notes:

• The ICS 201 can serve as part of the initial Incident Action Plan (IAP).

• If additional pages are needed for any form page, use a blank ICS 201 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 Date/Time Initiated

• Date, Time

Enter date initiated (month/day/year) and time initiated (using the 24-

hour clock).

4 Map/Sketch (include sketch,

showing the total area of

operations, the incident

site/area, impacted and

threatened areas, overflight

results, trajectories, impacted

shorelines, or other graphics

depicting situational status and

resource assignment)

Show perimeter and other graphics depicting situational status,

resource assignments, incident facilities, and other special information

on a map/sketch or with attached maps. Utilize commonly accepted

ICS map symbology.

If specific geospatial reference points are needed about the incident’s

location or area outside the ICS organization at the incident, that

information should be submitted on the Incident Status Summary (ICS

209).

North should be at the top of page unless noted otherwise.

5 Situation Summary and

Health and Safety Briefing (for

briefings or transfer of

command): Recognize potential

incident Health and Safety

Hazards and develop necessary

measures (remove hazard,

provide personal protective

equipment, warn people of the

hazard) to protect responders

from those hazards.

Self-explanatory.

6 Prepared by

• Name

• Position/Title

• Signature

• Date/Time

Enter the name, ICS position/title, and signature of the person

preparing the form. Enter date (month/day/year) and time prepared

(24-hour clock).

7 Current and Planned

Objectives

Enter the objectives used on the incident and note any specific problem

areas.

Block

Number

Block Title Instructions

8 Current and Planned Actions,

Strategies, and Tactics

• Time

• Actions

Enter the current and planned actions, strategies, and tactics and time

they may or did occur to attain the objectives. If additional pages are

needed, use a blank sheet or another ICS 201 (Page 2), and adjust

page numbers accordingly.

9 Current Organization (fill in

additional organization as

appropriate)

• Incident Commander(s)

• Liaison Officer

• Safety Officer

• Public Information Officer

• Planning Section Chief

• Operations Section Chief

• Finance/Administration

Section Chief

• Logistics Section Chief

• Enter on the organization chart the names of the individuals

assigned to each position.

• Modify the chart as necessary, and add any lines/spaces needed for

Command Staff Assistants, Agency Representatives, and the

organization of each of the General Staff Sections.

• If Unified Command is being used, split the Incident Commander

box.

• Indicate agency for each of the Incident Commanders listed if

Unified Command is being used.

10 Resource Summary

Enter the following information about the resources allocated to the

incident. If additional pages are needed, use a blank sheet or another

ICS 201 (Page 4), and adjust page numbers accordingly.

• Resource

Enter the number and appropriate category, kind, or type of resource

ordered.

• Resource Identifier

Enter the relevant agency designator and/or resource designator (if

any).

• Date/Time Ordered

Enter the date (month/day/year) and time (24-hour clock) the resource

was ordered.

• ETA

Enter the estimated time of arrival (ETA) to the incident (use 24-hour

clock).

• Arrived

Enter an “X” or a checkmark upon arrival to the incident.

• Notes (location/

assignment/status)

Enter notes such as the assigned location of the resource and/or the

actual assignment and status.

INCIDENT OBJECTIVES (ICS 202)

1. Incident Name:

2. Operational Period: Date From: Date To:

Time From: Time To:

3. Objective(s):

4. Operational Period Command Emphasis:

General Situational Awareness

5. Site Safety Plan Required? Yes  No 

Approved Site Safety Plan(s) Located at:

6. Incident Action Plan (the items checked below are included in this Incident Action Plan):

 ICS 203  ICS 207 Other Attachments:

 ICS 204  ICS 208 

 ICS 205  Map/Chart 

 ICS 205A  Weather Forecast/Tides/Currents 

 ICS 206 

7. Prepared by: Name: Position/Title: Signature:

8. Approved by Incident Commander: Name: Signature:

ICS 202

IAP Page _____

Date/Time:

ICS 202

Incident Objectives

Purpose. The Incident Objectives (ICS 202) describes the basic incident strategy, incident objectives, command

emphasis/priorities, and safety considerations for use during the next operational period.

Preparation. The ICS 202 is completed by the Planning Section following each Command and General Staff meeting

conducted to prepare the Incident Action Plan (IAP). In case of a Unified Command, one Incident Commander (IC) may

approve the ICS 202. If additional IC signatures are used, attach a blank page.

Distribution. The ICS 202 may be reproduced with the IAP and may be part of the IAP and given to all supervisory

personnel at the Section, Branch, Division/Group, and Unit levels. All completed original forms must be given to the

Documentation Unit.

Notes:

• The ICS 202 is part of the IAP and can be used as the opening or cover page.

• If additional pages are needed, use a blank ICS 202 and repaginate as needed.

Block

Number

Block Title Instructions

1 Incident Name

Enter the name assigned to the incident. If needed, an incident

number can be added.

2 Operational Period

• Date and Time From

• Date and Time To

Enter the start date (month/day/year) and time (using the 24-hour

clock) and end date and time for the operational period to which the

form applies.

3 Objective(s)

Enter clear, concise statements of the objectives for managing the

response. Ideally, these objectives will be listed in priority order.

These objectives are for the incident response for this operational

period as well as for the duration of the incident. Include alternative

and/or specific tactical objectives as applicable.

Objectives should follow the SMART model or a similar approach:

Specific – Is the wording precise and unambiguous?

Measurable – How will achievements be measured?

Action-oriented – Is an action verb used to describe expected

accomplishments?

Realistic – Is the outcome achievable with given available resources?

ime-sensitive – What is the timeframe?

4 Operational Period Command

Emphasis

Enter command emphasis for the operational period, which may

include tactical priorities or a general weather forecast for the

operational period. It may be a sequence of events or order of events

to address. This is not a narrative on the objectives, but a discussion

about where to place emphasis if there are needs to prioritize based

on the Incident Commander’s or Unified Command’s direction.

Examples: Be aware of falling debris, secondary explosions, etc.

General Situational Awareness General situational awareness may include a weather forecast,

incident conditions, and/or a general safety message. If a safety

message is included here, it should be reviewed by the Safety Officer

to ensure it is in alignment with the Safety Message/Plan (ICS 208).

5 Site Safety Plan Required?

Yes  No 

Safety Officer should check whether or not a site safety plan is

required for this incident.

Approved Site Safety Plan(s)

Located At

Enter the location of the approved Site Safety Plan(s).

Block

Number

Block Title Instructions

6 Incident Action Plan (the items

checked below are included in

this Incident Action Plan):

 ICS 203

 ICS 204

 ICS 205

 ICS 205A

 ICS 206

 ICS 207

 ICS 208

 Map/Chart

 Weather Forecast/

Tides/Currents

Other Attachments:

Check appropriate forms and list other relevant documents that are

included in the IAP.

 ICS 203 – Organization Assignment List

 ICS 204 – Assignment List

 ICS 205 – Incident Radio Communications Plan

 ICS 205A – Communications List

 ICS 206 – Medical Plan

 ICS 207 – Incident Organization Chart

 ICS 208 – Safety Message/Plan

7 Prepared by

• Name

• Position/Title

• Signature

Enter the name, ICS position, and signature of the person preparing

the form. Enter date (month/day/year) and time prepared (24-hour

clock).

8 Approved by Incident

Commander

• Name

• Signature

• Date/Time

In the case of a Unified Command, one IC may approve the ICS 202.

If additional IC signatures are used, attach a blank page.

ORGANIZATION ASSIGNMENT LIST (ICS 203)

1. Incident Name:

2. Operational Period: Date From: Date To:

Time From: Time To:

3. Incident Commander(s) and Command Staff: 7. Operations Section:

IC/UCs Chief

Deputy

Deputy Staging Area

Safety Officer

Branch

Public Info. Officer Branch Director

Liaison Officer Deputy

4. Agency/Organization Representatives:

Division/Group

Agency/Organization Name Division/Group

Division/Group

Branch

Branch Director

Deputy

5. Planning Section:

Division/Group

Chief Division/Group

Deputy Division/Group

Resources Unit Division/Group

Situation Unit Division/Group

Documentation Unit

Branch

Demobilization Unit Branch Director

Technical Specialists Deputy

Division/Group

6. Logistics Section:

Division/Group

Chief Division/Group

Deputy

Air Operations Branch

Support Branch

Air Ops Branch Dir.

Director

Supply Unit

Facilities Unit

8. Finance/Administration Section:

Ground Support Unit Chief

Service Branch

Deputy

Director Time Unit

Communications Unit Procurement Unit

Medical Unit Comp/Claims Unit

Food Unit Cost Unit

9. Prepared by: Name: Position/Title: Signature:

ICS 203 IAP Page _____

Date/Time:

ICS 203

Organization Assignment List

Purpose. The Organization Assignment List (ICS 203) provides ICS personnel with information on the units that are

currently activated and the names of personnel staffing each position/unit. It is used to complete the Incident

Organization Chart (ICS 207) which is posted on the Incident Command Post display. An actual organization will be

incident or event-specific. Not all positions need to be filled. Some blocks may contain more than one name. The size

of the organization is dependent on the magnitude of the incident, and can be expanded or contracted as necessary.

Preparation. The Resources Unit prepares and maintains this list under the direction of the Planning Section Chief.

Complete only the blocks for the positions that are being used for the incident. If a trainee is assigned to a position,

indicate this with a “T” in parentheses behind the name (e.g., “A. Smith (T)”).

Distribution. The ICS 203 is duplicated and attached to the Incident Objectives (ICS 202) and given to all recipients as

part of the Incident Action Plan (IAP). All completed original forms must be given to the Documentation Unit.

Notes:

• The ICS 203 serves as part of the IAP.

• If needed, more than one name can be put in each block by inserting a slash.

• If additional pages are needed, use a blank ICS 203 and repaginate as needed.

• ICS allows for organizational flexibility, so the Intelligence/Investigations Function can be embedded in several

different places within the organizational structure.

Block

Number

Block Title Instructions

1 Incident Name

Enter the name assigned to the incident.

2 Operational Period

• Date and Time From

• Date and Time To

Enter the start date (month/day/year) and time (using the 24-hour clock)

and end date and time for the operational period to which the form

applies.

3 Incident Commander(s)

and Command Staff

• IC/UCs

• Deputy

• Safety Officer

• Public Information Officer

• Liaison Officer

Enter the names of the Incident Commander(s) and Command Staff.

Label Assistants to Command Staff as such (for example, “Assistant

Safety Officer”).

For all individuals, use at least the first initial and last name.

For Unified Command, also include agency names.

4 Agency/Organization

Representatives

• Agency/Organization

• Name

Enter the agency/organization names and the names of their

representatives. For all individuals, use at least the first initial and last

name.

5 Planning Section

• Chief

• Deputy

• Resources Unit

• Situation Unit

• Documentation Unit

• Demobilization Unit

•

Technical Specialists

Enter the name of the Planning Section Chief, Deputy, and Unit Leaders

after each position title. List Technical Specialists with an indication of

specialty.

If there is a shift change during the specified operational period, list both

names, separated by a slash.

For all individuals, use at least the first initial and last name.

Block

Number

Block Title Instructions

6 Logistics Section

• Chief

• Deputy

Support Branch

• Director

• Supply Unit

• Facilities Unit

• Ground Support Unit

Service Branch

• Director

• Communications Unit

• Medical Unit

•

Food Unit

Enter the name of the Logistics Section Chief, Deputy, Branch Directors,

and Unit Leaders after each position title.

If there is a shift change during the specified operational period, list both

names, separated by a slash.

For all individuals, use at least the first initial and last name.

7 Operations Section

• Chief

• Deputy

• Staging Area

Branch

• Branch Director

• Deputy

• Division/Group

Air Operations Branch

• Air Operations Branch

Director

Enter the name of the Operations Section Chief, Deputy, Branch

Director(s), Deputies, and personnel staffing each of the listed positions.

For Divisions/Groups, enter the Division/Group identifier in the left column

and the individual’s name in the right column.

Branches and Divisions/Groups may be named for functionality or by

geography. For Divisions/Groups, indicate Division/Group Supervisor.

Use an additional page if more than three Branches are activated.

If there is a shift change during the specified operational period, list both

names, separated by a slash.

For all individuals, use at least the first initial and last name.

8 Finance/Administration

Section

• Chief

• Deputy

• Time Unit

• Procurement Unit

• Compensation/Claims

Unit

• Cost Unit

Enter the name of the Finance/Administration Section Chief, Deputy, and

Unit Leaders after each position title.

If there is a shift change during the specified operational period, list both

names, separated by a slash.

For all individuals, use at least the first initial and last name.

9 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 (24-hour clock).

ICS 204

Assignment List

Purpose. The Assignment List(s) (ICS 204) informs Division and Group supervisors of incident assignments. Once the

Command and General Staffs agree to the assignments, the assignment information is given to the appropriate Divisions

and Groups.

Preparation. The ICS 204 is normally prepared by the Resources Unit, using guidance from the Incident Objectives (ICS

202), Operational Planning Worksheet (ICS 215), and the Operations Section Chief. It must be approved by the Incident

Commander, but may be reviewed and initialed by the Planning Section Chief and Operations Section Chief as well.

Distribution. The ICS 204 is duplicated and attached to the ICS 202 and given to all recipients as part of the Incident

Action Plan (IAP). In some cases, assignments may be communicated via radio/telephone/fax. All completed original

forms must be given to the Documentation Unit.

Notes:

• The ICS 204 details assignments at Division and Group levels and is part of the IAP.

• Multiple pages/copies can be used if needed.

• If additional pages are needed, use a blank ICS 204 and repaginate as needed.

Block

Number

Block Title Instructions

1 Incident Name

Enter the name assigned to the incident.

2 Operational Period

• Date and Time From

• Date and Time To

Enter the start date (month/day/year) and time (using the 24-hour

clock) and end date and time for the operational period to which the

form applies.

3 Branch

Division

Group

Staging Area

This block is for use in a large IAP for reference only.

Write the alphanumeric abbreviation for the Branch, Division, Group,

and Staging Area (e.g., “Branch 1,” “Division D,” “Group 1A”) in large

letters for easy referencing.

4 Operations Personnel

• Name, Contact Number(s)

– Operations Section Chief

– Branch Director

– Division/Group Supervisor

Enter the name and contact numbers of the Operations Section Chief,

applicable Branch Director(s), and Division/Group Supervisor(s).

5 Resources Assigned

Enter the following information about the resources assigned to the

Division or Group for this period:

• Resource Identifier

The identifier is a unique way to identify a resource (e.g., ENG-13,

IA-SCC-413). If the resource has been ordered but no identification

has been received, use TBD (to be determined).

• Leader

Enter resource leader’s name.

• # of Persons

Enter total number of persons for the resource assigned, including the

leader.

• Contact (e.g., phone, pager,

radio frequency, etc.)

Enter primary means of contacting the leader or contact person (e.g.,

radio, phone, pager, etc.). Be sure to include the area code when

listing a phone number.

(continued)

• Reporting Location, Special

Equipment and Supplies,

Remarks, Notes, Information

Provide special notes or directions specific to this resource. If

required, add notes to indicate: (1) specific location/time where the

resource should report or be dropped off/picked up; (2) special

equipment and supplies that will be used or needed; (3) whether or not

the resource received briefings; (4) transportation needs; or (5) other

information.

Block

Number

Block Title Instructions

6 Work Assignments

Prov

ide a statement of the tactical objectives to be achieved within the

operational period by personnel assigned to this Division or Group.

7 Special Instructions

Enter a statement noting any safety problems, specific precautions to

be exercised, dropoff or pickup points, or other important information.

8 Communications (radio and/or

phone contact numbers needed

for this assignment)

• Name/Function

• Primary Contact: indicate

cell, pager, or radio

(frequency/system/channel)

Enter specific communications information (including emergency

numbers) for this Branch/Division/Group.

If radios are being used, enter function (command, tactical, support,

etc.), frequency, system, and channel from the Incident Radio

Communications Plan (ICS 205).

Phone and pager numbers should include the area code and any

satellite phone specifics.

In light of potential IAP distribution, use sensitivity when including cell

phone number.

Add a secondary contact (phone number or radio) if needed.

9 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 (24-hour

clock).

INCIDENT RADIO COMMUNICATIONS PLAN (ICS 205)

1. Incident Name:

2. Date/Time Prepared:

Date:

Time:

3. Operational Period:

Date From: Date To:

Time From: Time To:

4. Basic Radio Channel Use:

Zone

Grp.

# Function

Channel

Name/Trunked Radio

System Talkgroup Assignment

Freq

N or W

Tone/NAC

TX Freq

N or W

Tone/NAC

Mode

(A, D, or M)

Remarks

5. Special Instructions:

6. Prepared by (Communications Unit Leader): Name: Signature:

ICS 205

IAP Page _____

Date/Time:

click to sign

signature

click to edit

ICS 205

Incident Radio Communications Plan

Purpose. The Incident Radio Communications Plan (ICS 205) provides information on all radio frequency or trunked

radio system talkgroup assignments for each operational period. The plan is a summary of information obtained about

available radio frequencies or talkgroups and the assignments of those resources by the Communications Unit Leader for

use by incident responders. Information from the Incident Radio Communications Plan on frequency or talkgroup

assignments is normally placed on the Assignment List (ICS 204).

Preparation. The ICS 205 is prepared by the Communications Unit Leader and given to the Planning Section Chief for

inclusion in the Incident Action Plan.

Distribution. The ICS 205 is duplicated and attached to the Incident Objectives (ICS 202) and given to all recipients as

part of the Incident Action Plan (IAP). All completed original forms must be given to the Documentation Unit. Information

from the ICS 205 is placed on Assignment Lists.

Notes:

• The ICS 205 is used to provide, in one location, information on all radio frequency assignments down to the

Division/Group level for each operational period.

• The ICS 205 serves as part of the IAP.

Block

Number

Block Title Instructions

Incident Name

Enter the name assigned to the incident.

2 Date/Time Prepared

Enter date prepared (month/day/year) and time prepared (using the 24-hour

clock).

3 Operational Period

• Date and Time From

• Date and Time To

Enter the start date (month/day/year) and time (using the 24-hour clock) and

end date and time for the operational period to which the form applies.

4 Basic Radio Channel

Use

Enter the following information about radio channel use:

Zone Group

Channel Number Use at the Communications Unit Leader’s discretion. Channel Number (Ch

#) may equate to the channel number for incident radios that are

programmed or cloned for a specific Communications Plan, or it may be

used just as a reference line number on the ICS 205 document.

Function Enter the Net function each channel or talkgroup will be used for (Command,

Tactical, Ground-to-Air, Air-to-Air, Support, Dispatch).

Channel Name/Trunked

Radio System Talkgroup

Enter the nomenclature or commonly used name for the channel or talk

group such as the National Interoperability Channels which follow DHS

frequency Field Operations Guide (FOG).

Assignment Enter the name of the ICS Branch/Division/Group/Section to which this

channel/talkgroup will be assigned.

RX (Receive) Frequency

(N or W)

Enter the Receive Frequency (RX Freq) as the mobile or portable subscriber

would be programmed using xxx.xxxx out to four decimal places, followed by

an “N” designating narrowband or a “W” designating wideband emissions.

The name of the specific trunked radio system with which the talkgroup is

associated may be entered across all fields on the ICS 205 normally used

for conventional channel programming information.

RX Tone/NAC Enter the Receive Continuous Tone Coded Squelch System (CTCSS)

subaudible tone (RX Tone) or Network Access Code (RX NAC) for the

receive frequency as the mobile or portable subscriber would be

programmed.

Block

Number

Block Title Instructions

(continued)

TX (Transmit)

Frequency (N or W)

Enter the Transmit Frequency (TX Freq) as the mobile or portable subscriber

would be programmed using xxx.xxxx out to four decimal places, followed by

an “N” designating narrowband or a “W” designating wideband emissions.

TX Tone/NAC Enter the Transmit Continuous Tone Coded Squelch System (CTCSS)

subaudible tone (TX Tone) or Network Access Code (TX NAC) for the

transmit frequency as the mobile or portable subscriber would be

programmed.

Mode (A, D, or M) Enter “A” for analog operation, “D” for digital operation, or “M” for mixed

mode operation.

Remarks Enter miscellaneous information concerning repeater locations, information

concerning patched channels or talkgroups using links or gateways, etc.

5 Special Instructions

Enter any special instructions (e.g., using cross-band repeaters, secure-

voice, encoders, private line (PL) tones, etc.) or other emergency

communications needs). If needed, also include any special instructions for

handling an incident within an incident.

6 Prepared by

(Communications Unit

Leader)

• Name

• Signature

• Date/Time

Enter the name and signature of the person preparing the form, typically the

Communications Unit Leader. Enter date (month/day/year) and time

prepared (24-hour clock).

COMMUNICATIONS LIST (ICS 205A)

1. Incident Name:

2. Operational Period: Date From: Date To:

Time From: Time To:

3. Basic Local Communications Information:

Incident Assigned Position Name (Alphabetized)

Method(s) of Contact

(phone, pager, cell, etc.)

4. Prepared by: Name: Position/Title: Signature:

ICS 205A

IAP Page _____

Date/Time:

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ICS 205A

Communications List

Purpose. The Communications List (ICS 205A) records methods of contact for incident personnel. While the Incident

Radio Communications Plan (ICS 205) is used to provide information on all radio frequencies down to the Division/Group

level, the ICS 205A indicates all methods of contact for personnel assigned to the incident (radio frequencies, phone

numbers, pager numbers, etc.), and functions as an incident directory.

Preparation. The ICS 205A can be filled out during check-in and is maintained and distributed by Communications Unit

personnel. This form should be updated each operational period.

Distribution. The ICS 205A is distributed within the ICS organization by the Communications Unit, and posted as

necessary. All completed original forms must be given to the Documentation Unit. If this form contains sensitive

information such as cell phone numbers, it should be clearly marked in the header that it contains sensitive information

and is not for public release.

Notes:

• The ICS 205A is an optional part of the Incident Action Plan (IAP).

• This optional form is used in conjunction with the ICS 205.

• If additional pages are needed, use a blank ICS 205A and repaginate as needed.

Block

Number

Block Title Instructions

1 Incident Name

Enter the name assigned to the incident.

2 Operational Period

• Date and Time From

• Date and Time To

Enter the start date (month/day/year) and time (using the 24-hour

clock) and end date and time for the operational period to which the

form applies.

3 Basic Local Communications

Information

Enter the communications methods assigned and used for personnel

by their assigned ICS position.

• Incident Assigned Position

Enter the ICS organizational assignment.

• Name

Enter the name of the assigned person.

• Method(s) of Contact

(phone, pager, cell, etc.)

For each assignment, enter the radio frequency and contact number(s)

to include area code, etc. If applicable, include the vehicle license or

ID number assigned to the vehicle for the incident (e.g., HAZMAT 1,

etc.).

4 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 (24-hour

clock).

MEDICAL PLAN (ICS 206)

1. Incident Name:

2. Operational Period: Date From: Date To:

Time From: Time To:

3. Medical Aid Stations:

Name

Location

Contact

Number(s)/Frequency

Paramedics

on Site?

 Yes  No

4. Transportation (indicate air or ground):

Ambulance Service

Location

Contact

Number(s)/Frequency

Level of Service

 ALS  BLS

5. Hospitals:

Hospital Name

Address,

Latitude & Longitude

if Helipad

Contact

Number(s)/

Frequency

avel Time

auma

Center

Burn

Center Helipad

Air Ground

 Yes

Level:_____

 Yes

 No

 Yes

 No

 Yes

Level:_____

 Yes

 No

 Yes

 No

 Yes

Level:_____

 Yes

 No

 Yes

 No

 Yes

Level:_____

 Yes

 No

 Yes

 No

 Yes

Level:_____

 Yes

 No

 Yes

 No

6. Special Medical Emergency Procedures:

 Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations.

7. Prepared by (Medical Unit Leader): Name: Signature:

8. Approved by (Safety Officer): Name: Signature:

ICS 206

IAP Page _____

Date/Time:

ICS 206

Medical Plan

Purpose. The Medical Plan (ICS 206) provides information on incident medical aid stations, transportation services,

hospitals, and medical emergency procedures.

Preparation. The ICS 206 is prepared by the Medical Unit Leader and reviewed by the Safety Officer to ensure ICS

coordination. If aviation assets are utilized for rescue, coordinate with Air Operations.

Distribution. The ICS 206 is duplicated and attached to the Incident Objectives (ICS 202) and given to all recipients as

part of the Incident Action Plan (IAP). Information from the plan pertaining to incident medical aid stations and medical

emergency procedures may be noted on the Assignment List (ICS 204). All completed original forms must be given to the

Documentation Unit.

Notes:

• The ICS 206 serves as part of the IAP.

• This form can include multiple pages.

Block

Number

Block Title Instructions

1 Incident Name

Enter the name assigned to the incident.

2 Operational Period

• Date and Time From

• Date and Time To

Enter the start date (month/day/year) and time (using the 24-hour clock)

and end date and time for the operational period to which the form

applies.

Medical Aid Stations

Enter the following information on the incident medical aid station(s):

• Name

Enter name of the medical aid station.

• Location

Enter the location of the medical aid station (e.g., Staging Area, Camp

Ground).

• Contact

Number(s)/Frequency

Enter the contact number(s) and frequency for the medical aid

station(s).

• Paramedics on Site?

 Yes  No

Indicate (yes or no) if paramedics are at the site indicated.

4 Transportation (indicate air or

ground)

Enter the following information for ambulance services available to the

incident:

• Ambulance Service

Enter name of ambulance service.

• Location

Enter the location of the ambulance service.

• Contact

Number(s)/Frequency

Enter the contact number(s) and frequency for the ambulance service.

• Level of Service

 ALS  BLS

Indicate the level of service available for each ambulance, either ALS

(Advanced Life Support) or BLS (Basic Life Support).

Block

Number

Block Title Instructions

5 Hospitals

Enter the following information for hospital(s) that could serve this

incident:

• Hospital Name

Enter hospital name and identify any predesignated medivac aircraft by

name a frequency.

• Address, Latitude &

Longitude if Helipad

Enter the physical address of the hospital and the latitude and longitude

if the hospital has a helipad.

• Contact Number(s)/

Frequency

Enter the contact number(s) and/or communications frequency(s) for

the hospital.

• Travel Time

• Air

• Ground

Enter the travel time by air and ground from the incident to the hospital.

• Trauma Center

 Yes Level:______

Indicate yes and the trauma level if the hospital has a trauma center.

• Burn Center

 Yes  No

Indicate (yes or no) if the hospital has a burn center.

• Helipad

 Yes  No

Indicate (yes or no) if the hospital has a helipad.

Latitude and Longitude data format need to compliment Medical

Evacuation Helicopters and Medical Air Resources

6 Special Medical Emergency

Procedures

Note any special emergency instructions for use by incident personnel,

including (1) who should be contacted, (2) how should they be

contacted; and (3) who manages an incident within an incident due to a

rescue, accident, etc. Include procedures for how to report medical

emergencies.

 Check box if aviation assets

are utilized for rescue. If

assets are used, coordinate

with Air Operations.

Self explanatory. Incident assigned aviation assets should be included

in ICS 220.

7 Prepared by (Medical Unit

Leader)

• Name

• Signature

Enter the name and signature of the person preparing the form, typically

the Medical Unit Leader. Enter date (month/day/year) and time

prepared (24-hour clock).

8 Approved by (Safety Officer)

• Name

• Signature

•

Date/Time

Enter the name of the person who approved the plan, typically the

Safety Officer. Enter date (month/day/year) and time reviewed (24-hour

clock).

3. Organization Chart

INCIDENT ORGANIZATION CHART (ICS 207)

1. Incident Name:

2. Operational Period: Date From: Date To:

Time From: Time To:

ICS 207

IAP Page ___

4. Prepared by:

Name: Position/Title: Signature: Date/Time:

Safety Officer

Public Information Officer

Liaison Officer

Incident Commander(s)

Operations Section

Chief

Staging Area

Manager

Logistics Section

Chief

Support Branch Dir.

Supply Unit Ldr.

Facilities Unit Ldr.

Ground Spt. Unit Ldr.

Service Branch Dir.

Comms Unit Ldr.

Medical Unit Ldr.

Food Unit Ldr.

Planning Section

Chief

Resources Unit Ldr.

Situation Unit Ldr.

Documentation Unit Ldr.

Demobilization Unit Ldr.

Finance/Admin

Section Chief

Time Unit Ldr.

Procurement Unit Ldr.

Comp./Claims Unit Ldr.

Cost Unit Ldr.

ICS 207

Incident Organization Chart

Purpose. The Incident Organization Chart (ICS 207) provides a visual wall chart depicting the ICS organization position

assignments for the incident. The ICS 207 is used to indicate what ICS organizational elements are currently activated

and the names of personnel staffing each element. An actual organization will be event-specific. The size of the

organization is dependent on the specifics and magnitude of the incident and is scalable and flexible. Personnel

responsible for managing organizational positions are listed in each box as appropriate.

Preparation. The ICS 207 is prepared by the Resources Unit Leader and reviewed by the Incident Commander.

Complete only the blocks where positions have been activated, and add additional blocks as needed, especially for

Agency Representatives and all Operations Section organizational elements. For detailed information about positions,

consult the NIMS ICS Field Operations Guide. The ICS 207 is intended to be used as a wall-size chart and printed on a

plotter for better visibility. A chart is completed for each operational period, and updated when organizational changes

occur.

Distribution. The ICS 207 is intended to be wall mounted at Incident Command Posts and other incident locations as

needed, and is not intended to be part of the Incident Action Plan (IAP). All completed original forms must be given to the

Documentation Unit.

Notes:

• The ICS 207 is intended to be wall mounted (printed on a plotter). Document size can be modified based on individual

needs.

• Also available as 8½ x 14 (legal size) chart.

• ICS allows for organizational flexibility, so the Intelligence/Investigative Function can be embedded in several different

places within the organizational structure.

• Use additional pages if more than three branches are activated. Additional pages can be added based on individual

need (such as to distinguish more Division/Groups and Branches as they are activated).

Block

Number

Block Title Instructions

1 Incident Name

Print the name assigned to the incident.

2 Operational Period

• Date and Time From

• Date and Time To

Enter the start date (month/day/year) and time (using the

24-hour clock) and end date and time for the operational

period to which the form applies.

3 Organization Chart

• Complete the incident organization chart.

• For all individuals, use at least the first initial and last

name.

• List agency where it is appropriate, such as for Unified

Commanders.

• If there is a shift change during the specified operational

period, list both names, separated by a slash.

4 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 (24-hour clock).

SAFETY MESSAGE/PLAN (ICS 208)

1. Incident Name:

2. Operational Period: Date From: Date To:

Time From: Time To:

3. Safety Message/Expanded Safety Message, Safety Plan, Site Safety Plan:

4. Site Safety Plan Required? Yes  No 

Approved Site Safety Plan(s) Located At:

5. Prepared by: Name: Position/Title: Signature:

ICS 208

IAP Page _____

Date/Time:

ICS 208

Safety Message/Plan

Purpose. The Safety Message/Plan (ICS 208) expands on the Safety Message and Site Safety Plan.

Preparation. The ICS 208 is an optional form that may be included and completed by the Safety Officer for the Incident

Action Plan (IAP).

Distribution. The ICS 208, if developed, will be reproduced with the IAP and given to all recipients as part of the IAP. All

completed original forms must be given to the Documentation Unit.

Notes:

• The ICS 208 may serve (optionally) as part of the IAP.

• Use additional copies for continuation sheets as needed, and indicate pagination as used.

Block

Number

Block Title Instructions

Incident Name

Enter the name assigned to the incident.

Operational Period

• Date and Time From

• Date and Time To

Enter the start date (month/day/year) and time (using the 24-hour

clock) and end date and time for the operational period to which the

form applies.

Safety Message/Expanded

Safety Message, Safety Plan,

Site Safety Plan

Enter clear, concise statements for safety message(s), priorities, and

key command emphasis/decisions/directions. Enter information such

as known safety hazards and specific precautions to be observed

during this operational period. If needed, additional safety message(s)

should be referenced and attached.

4 Site Safety Plan Required?

Yes  No 

Check whether or not a site safety plan is required for this incident.

Approved Site Safety Plan(s)

Located At

Enter where the approved Site Safety Plan(s) is located.

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 (24-hour

clock).

SITE SAFETY AND

CONTROL PLAN

ICS 208 HM

1. Incident Name:

2. Date Prepared:

3. Operational Period:

Time:

Section I. Site Information

4. Incident Location:

Section II. Organization

5. Incident Commander: 6. HM Group Supervisor: 7. Tech. Specialist - HM Reference:

8. Safety Officer: 9. Entry Leader: 10. Site Access Control Leader:

11. Asst. Safety Officer - HM: 12. Decontamination Leader: 13. Safe Refuge Area Mgr:

14. Environmental Health: 15. 16.

17. Entry Team: (Buddy System)

Name: PPE Level

18. Decontamination Element:

Name: PPE Level

Entry 1 Decon 1

Entry 2 Decon 2

Entry 3 Decon 3

Entry 4 Decon 4

Section III. Hazard/Risk Analysis

19. Material: Container

type

Qty. Phys.

State

pH IDLH F.P. I.T. V.P. V.D. S.G. LEL UEL

Comment:

Section IV. Hazard Monitoring

20. LEL Instrument(s): 21. O

Instrument(s):

22. Toxicity/PPM Instrument(s): 23. Radiological Instrument(s):

Comment:

Section V. Decontamination Procedures

24. Standard Decontamination Procedures: YES: NO:

Comment:

Section VI. Site Communications

25. Command Frequency: 26. Tactical Frequency: 27. Entry Frequency:

Section VII. Medical Assistance

28. Medical Monitoring: YES: NO: 29. Medical Treatment and Transport In-place: YES: NO:

Comment:

ICS 208 HM Page 1 3/98

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Section VIII. Site Map

30. Site Map:

Weather

❏ Command Post

❏

Zones

❏

Assembly Areas ❏ Escape Routes ❏ Other ❏

Section IX. Entry Objectives

31. Entry Objectives:

Section X. SOP S and Safe Work Practices

32. Modifications to Documented SOP s or Work Practices: YES: NO:

Comment:

Section XI. Emergency Procedures

33. Emergency Procedures:

Section XII. Safety Briefing

34. Asst. Safety Officer - HM Signature: Safety Briefing Completed (Time):

35. HM Group Supervisor Signature: 36. Incident Commander Signature:

ICS 208 HM Page 2 3/98

INSTRUCTIONS FOR COMPLETING THE SITE SAFETY AND CONTROL PLAN

ICS 208 HM

A Site Safety and Control Plan must be completed by the Hazardous Materials Group Supervisor and reviewed by all

within the Hazardous Materials Group prior to operations commencing within the Exclusion Zone.

Item Number Item Title Instructions

1. Incident Name/Number Print name and/or incident number.

2. Date and Time Enter date and time prepared.

3. Operational Period Enter the time interval for which the form applies.

4. Incident Location Enter the address and or map coordinates of the incident.

5 - 16. Organization Enter names of all individuals assigned to ICS positions. (Entries 5 &

8 mandatory). Use Boxes 15 and 16 for other functions: i.e. Medical

Monitoring.

17 - 18. Entry Team/Decon Enter names and level of PPE of Entry & Decon personnel. (Entries 1

Element - 4 mandatory buddy system and back-up.)

19. Material Enter names and pertinent information of all known chemical

products. Enter UNK if material is not known. Include any which

apply to chemical properties. (Definitions: ph = Potential for Hydrogen

(Corrosivity), IDLH = Immediately Dangerous to Life and Health,

F.P. = Flash Point, I.T. = Ignition Temperature, V.P. = Vapor Pressure,

V.D. = Vapor Density, S.G. = Specific Gravity, LEL = Lower Explosive

Limit, UEL = Upper Explosive Limit)

20 - 23. Hazard Monitoring List the instruments which will be used to monitor for chemical.

24. Decontamination Check NO if modifications are made to standard decontamination

Procedures procedures and make appropriate Comments including type of

solutions.

25 - 27. Site Communications Enter the radio frequency(ies) which apply.

28 - 29. Medical Assistance Enter comments if NO is checked.

30. Site Map Sketch or attach a site map which defines all locations and layouts of

operational zones. (Check boxes are mandatory to be identified.)

31. Entry Objectives List all objectives to be performed by the Entry Team in the

Exclusion Zone and any parameters which will alter or stop entry

operations.

32 - 33. SOP s, Safe Work List in Comments if any modifications to SOP s and any emergency

Practices, and procedures which will be affected if an emergency occurs while

Emergency personnel are within the Exclusion Zone.

Procedures

34 - 36. Safety Briefing Have the appropriate individual place their signature in the box once

the Site Safety and Control Plan is reviewed.

Note the time in box 34 when the safety briefing has been completed.

ICS 208 HM Page 3 3/98

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

 F

inal

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.

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INCIDENT STATUS SUMMARY (ICS 209)

*1. Incident Name:

2. Incident Number:

Additional Incident Decision Support Information

*31. Public Status Summary:

A. # This

Reporting

Period

B. Total #

to Date

*32. Responder Status Summary:

A. # This

Reporting

Period

B. Total #

to Date

C. Indicate Number of Civilians (Public) Below:

C. Indicate Number of Responders Below:

D. Fatalities

E. With Injuries/Illness

F. Trapped/In Need of Rescue

G. Missing (note if estimated)

G. Missing

H. Evacuated (note if estimated)

H. Sheltering in Place

I. Sheltering in Place (note if estimated)

I. Have Received Immunizations

J. In Temporary Shelters (note if est.)

J. Require Immunizations

K. Have Received Mass Immunizations

K. In Quarantine

L. Require Immunizations (note if est.)

M. In Quarantine

N. Total # Civilians (Public) Affected:

N. Total # Responders Affected:

33. Life, Safety, and Health Status/Threat Remarks: *34. Life, Safety, and Health Threat

Management:

A. Check if Active

A. No Likely Threat



B. Potential Future Threat



C. Mass Notifications in Progress



D. Mass Notifications Completed



E. No Evacuation(s) Imminent



F. Planning for Evacuation



G. Planning for Shelter-in-Place



35. Weather Concerns (synopsis of current and predicted

weather; discuss related factors that may cause concern):

H. Evacuation(s) in Progress



I. Shelter-in-Place in Progress



J. Repopulation in Progress



K. Mass Immunization in Progress



L. Mass Immunization Complete



M. Quarantine in Progress



N. Area Restriction in Effect



36. Projected Incident Activity, Potential, Movement, Escalation, or Spread

and influencing factors during the next operational

period and in 12-, 24-, 48-, and 72-hour timeframes:

12 hours:

24 hours:

48 hours:

72 hours:

Anticipated after 72 hours:

37. Strategic Objectives

(define planned end-state for incident)

ICS 209, Page 2 of ___

* Required when applicable.

INCIDENT STATUS SUMMARY (ICS 209)

1. Incident Name:

2. Incident Number:

Incident Resource Commitment Summary

48. Agency or

Organization:

49. Resources (summarize resources by category, kind, and/or type; show # of

resources on top ½ of box, show # of personnel associated with resource on

bottom ½ of box):

50. Additional Personnel

not assigned to a

resource:

51. Total

Personnel

(includes those

associated

with resources

– e.g., aircraft

or engines –

and individual

overhead):

52. Total

Resources

53. Additional Cooperating and Assisting Organizations Not Listed Above:

ICS 209, Page ___ of ___

* Required when applicable.

ICS 209

Incident Status Summary

Purpose. The ICS 209 is used for reporting information on significant incidents. It is not intended for every incident, as

most incidents are of short duration and do not require scarce resources, significant mutual aid, or additional support and

attention. The ICS 209 contains basic information elements needed to support decisionmaking at all levels above the

incident to support the incident. Decisionmakers may include the agency having jurisdiction, but also all multiagency

coordination system (MACS) elements and parties, such as cooperating and assisting agencies/organizations, dispatch

centers, emergency operations centers, administrators, elected officials, and local, tribal, county, State, and Federal

agencies. Once ICS 209 information has been submitted from the incident, decisionmakers and others at all incident

support and coordination points may transmit and share the information (based on its sensitivity and appropriateness) for

access and use at local, regional, State, and national levels as it is needed to facilitate support.

Accurate and timely completion of the ICS 209 is necessary to identify appropriate resource needs, determine allocation

of limited resources when multiple incidents occur, and secure additional capability when there are limited resources due

to constraints of time, distance, or other factors. The information included on the ICS 209 influences the priority of the

incident, and thus its share of available resources and incident support.

The ICS 209 is designed to provide a “snapshot in time” to effectively move incident decision support information where it

is needed. It should contain the most accurate and up-to-date information available at the time it is prepared. However,

readers of the ICS 209 may have access to more up-to-date or real-time information in reference to certain information

elements on the ICS 209. Coordination among communications and information management elements within ICS and

among MACS should delineate authoritative sources for more up-to-date and/or real-time information when ICS 209

information becomes outdated in a quickly evolving incident.

Reporting Requirements. The ICS 209 is intended to be used when an incident reaches a certain threshold where it

becomes significant enough to merit special attention, require additional resource support needs, or cause media

attention, increased public safety threat, etc. Agencies or organizations may set reporting requirements and, therefore,

ICS 209s should be completed according to each jurisdiction or discipline’s policies, mobilization guide, or preparedness

plans. It is recommended that consistent ICS 209 reporting parameters be adopted and used by jurisdictions or

disciplines for consistency over time, documentation, efficiency, trend monitoring, incident tracking, etc.

For example, an agency or MAC (Multiagency Coordination) Group may require the submission of an initial ICS 209 when

a new incident has reached a certain predesignated level of significance, such as when a given number of resources are

committed to the incident, when a new incident is not completed within a certain timeframe, or when impacts/threats to life

and safety reach a given level.

Typically, ICS 209 forms are completed either once daily or for each operational period – in addition to the initial

submission. Jurisdictional or organizational guidance may indicate frequency of ICS 209 submission for particular

definitions of incidents or for all incidents. This specific guidance may help determine submission timelines when

operational periods are extremely short (e.g., 2 hours) and it is not necessary to submit new ICS 209 forms for all

operational periods.

Any plans or guidelines should also indicate parameters for when it is appropriate to stop submitting ICS 209s for an

incident, based upon incident activity and support levels.

Preparation. When an Incident Management Organization (such as an Incident Management Team) is in place, the

Situation Unit Leader or Planning Section Chief prepares the ICS 209 at the incident. On other incidents, the ICS 209

may be completed by a dispatcher in the local communications center, or by another staff person or manager. This form

should be completed at the incident or at the closest level to the incident.

The ICS 209 should be completed with the best possible, currently available, and verifiable information at the time it is

completed and signed.

This form is designed to serve incidents impacting specific geographic areas that can easily be defined. It also has the

flexibility for use on ubiquitous events, or those events that cover extremely large areas and that may involve many

jurisdictions and ICS organizations. For these incidents, it will be useful to clarify on the form exactly which portion of the

larger incident the ICS 209 is meant to address. For example, a particular ICS 209 submitted during a statewide outbreak

of mumps may be relevant only to mumps-related activities in Story County, Iowa. This can be indicated in both the

incident name, Block 1, and in the Incident Location Information section in Blocks 16–26.

While most of the “Incident Location Information” in Blocks 16–26 is optional, the more information that can be submitted,

the better. Submission of multiple location indicators increases accuracy, improves interoperability, and increases

information sharing between disparate systems. Preparers should be certain to follow accepted protocols or standards

when entering location information, and clearly label all location information. As with other ICS 209 data, geospatial

information may be widely shared and utilized, so accuracy is essential.

If electronic data is submitted with the ICS 209, do not attach or send extremely large data files. Incident geospatial data

that is distributed with the ICS 209 should be in simple incident geospatial basics, such as the incident perimeter, point of

origin, etc. Data file sizes should be small enough to be easily transmitted through dial-up connections or other limited

communications capabilities when ICS 209 information is transmitted electronically. Any attached data should be clearly

labeled as to format content and collection time, and should follow existing naming conventions and standards.

Distribution. ICS 209 information is meant to be completed at the level as close to the incident as possible, preferably at

the incident. Once the ICS 209 has been submitted outside the incident to a dispatch center or MACS element, it may

subsequently be transmitted to various incident supports and coordination entities based on the support needs and the

decisions made within the MACS in which the incident occurs.

Coordination with public information system elements and investigative/intelligence information organizations at the

incident and within MACS is essential to protect information security and to ensure optimal information sharing and

coordination. There may be times in which particular ICS 209s contain sensitive information that should not be released

to the public (such as information regarding active investigations, fatalities, etc.). When this occurs, the ICS 209 (or

relevant sections of it) should be labeled appropriately, and care should be taken in distributing the information within

MACS.

All completed and signed original ICS 209 forms MUST be given to the incident’s Documentation Unit and/or maintained

as part of the official incident record.

Notes:

• To promote flexibility, only a limited number of ICS 209 blocks are typically required, and most of those are required

only when applicable.

• Most fields are optional, to allow responders to use the form as best fits their needs and protocols for information

collection.

• For the purposes of the ICS 209, responders are those personnel who are assigned to an incident or who are a part of

the response community as defined by NIMS. This may include critical infrastructure owners and operators,

nongovernmental and nonprofit organizational personnel, and contract employees (such as caterers), depending on

local/jurisdictional/discipline practices.

• For additional flexibility only pages 1–3 are numbered, for two reasons:

o Possible submission of additional pages for the Remarks Section (Block 47), and

o Possible submission of additional copies of the fourth/last page (the “Incident Resource Commitment Summary”) to

provide a more detailed resource summary.

Block

Number

Block Title Instructions

*1 Incident Name REQUIRED BLOCK.

• Enter the full name assigned to the incident.

• Check spelling of the full incident name.

• For an incident that is a Complex, use the word “Complex” at the end of

the incident name.

• If the name changes, explain comments in Remarks, Block 47.

• Do not use the same incident name for different incidents in the same

calendar year.

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Block

Number

Block Title Instructions

2 Incident Number

• Enter the appropriate number based on current guidance. The incident

number may vary by jurisdiction and discipline.

• Examples include:

o A computer-aided dispatch (CAD) number.

o An accounting number.

o A county number.

o A disaster declaration number.

o A combination of the State, unit/agency ID, and a dispatch system

number.

o A mission number.

o Any other unique number assigned to the incident and derived by

means other than those above.

• Make sure the number entered is correct.

• Do not use the same incident number for two different incidents in the

same calendar year.

• Incident numbers associated with host jurisdictions or agencies and

incident numbers assigned by agencies represented in Unified Command

should be listed, or indicated in Remarks, Block 47.

*3 Report Version (check

one box on left)

REQUIRED BLOCK.

• This indicates the current version of the ICS 209 form being submitted.

• If only one ICS 209 will be submitted, check BOTH “Initial” and “Final” (or

check only “Final”).

 Initial

Check “Initial” if this is the first ICS 209 for this incident.

 Update

Check “Update” if this is a subsequent report for the same incident. These

can be submitted at various time intervals (see “Reporting Requirements”

above).

 Final

• Check “Final” if this is the last ICS 209 to be submitted for this incident

(usually when the incident requires only minor support that can be

supplied by the organization having jurisdiction).

• Incidents may also be marked as “Final” if they become part of a new

Complex (when this occurs, it can be indicated in Remarks, Block 47).

Report # (if used) Use this optional field if your agency or organization requires the tracking of

ICS 209 report numbers. Agencies may also track the ICS 209 by the

date/time submitted.

*4 Incident Commander(s)

& Agency or

Organization

REQUIRED BLOCK.

• Enter both the first and last name of the Incident Commander.

• If the incident is under a Unified Command, list all Incident Commanders

by first initial and last name separated by a comma, including their

organization. For example:

L. Burnett – Minneapolis FD, R. Domanski – Minneapolis PD,

C. Taylor – St. Paul PD, Y. Martin – St. Paul FD,

S. McIntyre – U.S. Army Corps, J. Hartl – NTSB

5 Incident Management

Organization

Indicate the incident management organization for the incident, which may

be a Type 1, 2, or 3 Incident Management Team (IMT), a Unified Command,

a Unified Command with an IMT, etc. This block should not be completed

unless a recognized incident management organization is assigned to the

incident.

Block

Number

Block Title Instructions

*6 Incident Start Date/Time REQUIRED.

This is always the start date and time of the incident (not the report date and

time or operational period).

Date Enter the start date (month/day/year).

Time Enter the start time (using the 24-hour clock).

Time Zone Enter the time zone of the incident (e.g., EDT, PST).

7 Current Incident Size or

Area Involved (use unit

label – e.g., “sq mi,” “city

block”)

• Enter the appropriate incident descriptive size or area involved (acres,

number of buildings, square miles, hectares, square kilometers, etc.).

• Enter the total area involved for incident Complexes in this block, and list

each sub-incident and size in Remarks (Block 47).

• Indicate that the size is an estimate, if a more specific figure is not

available.

• Incident size may be a population figure rather than a geographic figure,

depending on the incident definition and objectives.

• If the incident involves more than one jurisdiction or mixed ownership,

agencies/organizations may require listing a size breakdown by

organization, or including this information in Remarks (Block 47).

• The incident may be one part of a much larger event (refer to introductory

instructions under “Preparation). Incident size/area depends on the area

actively managed within the incident objectives and incident operations,

and may also be defined by a delegation of authority or letter of

expectation outlining management bounds.

8 Percent (%) Contained

or Completed (circle one)

• Enter the percent that this incident is completed or contained (e.g., 50%),

with a % label.

• For example, a spill may be 65% contained, or flood response objectives

may be 50% met.

*9 Incident Definition REQUIRED BLOCK.

Enter a general definition of the incident in this block. This may be a general

incident category or kind description, such as “tornado,” “wildfire,” “bridge

collapse,” “civil unrest,” “parade,” “vehicle fire,” “mass casualty,” etc.

10 Incident Complexity

Level

Identify the incident complexity level as determined by Unified/Incident

Commanders, if available or used.

*11 For Time Period REQUIRED BLOCK.

• Enter the time interval for which the form applies. This period should

include all of the time since the last ICS 209 was submitted, or if it is the

initial ICS 209, it should cover the time lapsed since the incident started.

• The time period may include one or more operational periods, based on

agency/organizational reporting requirements.

From Date/Time

• Enter the start date (month/day/year).

• Enter the start time (using the 24-hour clock).

To Date/Time

• Enter the end date (month/day/year).

• Enter the end time (using the 24-hour clock).

Block

Number

Block Title Instructions

APPROVAL & ROUTING INFORMATION

*12 Prepared By REQUIRED BLOCK.

When an incident management organization is in place, this would be the

Situation Unit Leader or Planning Section Chief at the incident. On other

incidents, it could be a dispatcher in the local emergency communications

center, or another staff person or manager.

Print Name Print the name of the person preparing the form.

ICS Position The ICS title of the person preparing the form (e.g., “Situation Unit Leader”).

Date/Time Prepared Enter the date (month/day/year) and time (using the 24-hour clock) the form

was prepared. Enter the time zone if appropriate.

*13 Date/Time Submitted REQUIRED.

Enter the submission date (month/day/year) and time (using the 24-hour

clock).

Time Zone

Enter the time zone from which the ICS 209 was submitted (e.g., EDT,

PST).

*14 Approved By REQUIRED.

When an incident management organization is in place, this would be the

Planning Section Chief or Incident Commander at the incident. On other

incidents, it could be the jurisdiction’s dispatch center manager,

organizational administrator, or other manager.

Print Name Print the name of the person approving the form.

ICS Position The position of the person signing the ICS 209 should be entered (e.g.,

“Incident Commander”).

Signature Signature of the person approving the ICS 209, typically the Incident

Commander. The original signed ICS 209 should be maintained with other

incident documents.

*15 Primary Location,

Organization, or Agency

Sent To

REQUIRED BLOCK.

Enter the appropriate primary location or office the ICS 209 was sent to

apart from the incident. This most likely is the entity or office that ordered

the incident management organization that is managing the incident. This

may be a dispatch center or a MACS element such as an emergency

operations center. If a dispatch center or other emergency center prepared

the ICS 209 for the incident, indicate where it was submitted initially.

INCIDENT LOCATION INFORMATION

• Much of the “Incident Location Information” in Blocks 16–26 is optional, but completing as many fields as possible

increases accuracy, and improves interoperability and information sharing between disparate systems.

• As with all ICS 209 information, accuracy is essential because the information may be widely distributed and used in

a variety of systems. Location and/or geospatial data may be used for maps, reports, and analysis by multiple

parties outside the incident.

• Be certain to follow accepted protocols, conventions, or standards where appropriate when submitting location

information, and clearly label all location information.

• Incident location information is usually based on the point of origin of the incident, and the majority of the area

where the incident jurisdiction is.

*16 State REQUIRED BLOCK WHEN APPLICABLE.

• Enter the State where the incident originated.

• If other States or jurisdictions are involved, enter them in Block 25 or

Block 44.

Block

Number

Block Title Instructions

*17 County / Parish /

Borough

REQUIRED BLOCK WHEN APPLICABLE.

• Enter the county, parish, or borough where the incident originated.

• If other counties or jurisdictions are involved, enter them in Block 25 or

Block 47.

*18 City REQUIRED BLOCK WHEN APPLICABLE.

• Enter the city where the incident originated.

• If other cities or jurisdictions are involved, enter them in Block 25 or Block

47.

19 Unit or Other

Enter the unit, sub-unit, unit identification (ID) number or code (if used), or

other information about where the incident originated. This may be a local

identifier that indicates primary incident jurisdiction or responsibility (e.g.,

police, fire, public works, etc.) or another type of organization. Enter

specifics in Block 25.

*20 Incident Jurisdiction REQUIRED BLOCK WHEN APPLICABLE.

Enter the jurisdiction where the incident originated (the entry may be

general, such as Federal, city, or State, or may specifically identify agency

names such as Warren County, U.S. Coast Guard, Panama City, NYPD).

21 Incident Location

Ownership (if different

than jurisdiction)

• When relevant, indicate the ownership of the area where the incident

originated, especially if it is different than the agency having jurisdiction.

• This may include situations where jurisdictions contract for emergency

services, or where it is relevant to include ownership by private entities,

such as a large industrial site.

22 22. Longitude (indicate

format):

Latitude

(indicate

format)

• Enter the longitude and latitude where the incident originated, if available

and normally used by the authority having jurisdiction for the incident.

• Clearly label the data, as longitude and latitude can be derived from

various sources. For example, if degrees, minutes, and seconds are

used, label as “33 degrees, 45 minutes, 01 seconds.”

23 US National Grid

Reference

• Enter the US National Grid (USNG) reference where the incident

originated, if available and commonly used by the agencies/jurisdictions

with primary responsibility for the incident.

• Clearly label the data.

24 Legal Description

(township, section, range)

• Enter the legal description where the incident originated, if available and

commonly used by the agencies/jurisdictions with primary responsibility

for the incident.

• Clearly label the data (e.g., N 1/2 SE 1/4, SW 1/4, S24, T32N, R18E).

*25 Short Location or Area

Description (list all

affected areas or a

reference point)

REQUIRED BLOCK.

• List all affected areas as described in instructions for Blocks 16–24

above, OR summarize a general location, OR list a reference point for

the incident (e.g., “the southern third of Florida,” “in ocean 20 miles west

of Catalina Island, CA,” or “within a 5 mile radius of Walden, CO”).

• This information is important for readers unfamiliar with the area (or with

other location identification systems) to be able to quickly identify the

general location of the incident on a map.

• Other location information may also be listed here if needed or relevant

for incident support (e.g., base meridian).

26 UTM Coordinates

Indicate Universal Transverse Mercator reference coordinates if used by the

discipline or jurisdiction.

Block

Number

Block Title Instructions

27 Note any electronic

geospatial data included

or attached (indicate data

format, content, and

collection time information

and labels)

• Indicate whether and how geospatial data is included or attached.

• Utilize common and open geospatial data standards.

• WARNING: Do not attach or send extremely large data files with the ICS

209. Incident geospatial data that is distributed with the ICS 209 should

be simple incident geospatial basics, such as the incident perimeter,

origin, etc. Data file sizes should be small enough to be easily

transmitted through dial-up connections or other limited communications

capabilities when ICS 209 information is transmitted electronically.

• NOTE: Clearly indicate data content. For example, data may be about

an incident perimeter (such as a shape file), the incident origin (a point),

a point and radius (such as an evacuation zone), or a line or lines (such

as a pipeline).

• NOTE: Indicate the data format (e.g., .shp, .kml, .kmz, or .gml file) and

any relevant information about projection, etc.

• NOTE: Include a hyperlink or other access information if incident map

data is posted online or on an FTP (file transfer protocol) site to facilitate

downloading and minimize information requests.

• NOTE: Include a point of contact for getting geospatial incident

information, if included in the ICS 209 or available and supporting the

incident.

INCIDENT SUMMARY

*28 Significant Events for

the Time Period

Reported (summarize

significant progress made,

evacuations, incident

growth, etc.)

REQUIRED BLOCK.

• Describe significant events that occurred during the period being

reported in Block 6. Examples include:

o Road closures.

o Evacuations.

o Progress made and accomplishments.

o Incident command transitions.

o Repopulation of formerly evacuated areas and specifics.

o Containment.

• Refer to other blocks in the ICS 209 when relevant for additional

information (e.g., “Details on evacuations may be found in Block 33”), or

in Remarks, Block 47.

• Be specific and detailed in reference to events. For example, references

to road closures should include road number and duration of closure (or

include further detail in Block 33). Use specific metrics if needed, such

as the number of people or animals evacuated, or the amount of a

material spilled and/or recovered.

• This block may be used for a single-paragraph synopsis of overall

incident status.

29 Primary Materials or

Hazards Involved

(hazardous chemicals,

fuel types, infectious

agents, radiation, etc.)

• When relevant, enter the appropriate primary materials, fuels, or other

hazards involved in the incident that are leaking, burning, infecting, or

otherwise influencing the incident.

• Examples include hazardous chemicals, wildland fuel models,

biohazards, explosive materials, oil, gas, structural collapse, avalanche

activity, criminal activity, etc.

Other Enter any miscellaneous issues which impacted Critical Infrastructure and

Key Resources.

Block

Number

Block Title Instructions

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.)

• Include a short summary of damage or use/access restrictions/

limitations caused by the incident for the reporting period, and

cumulatively.

• Include if needed any information on the facility status, such as

operational status, if it is evacuated, etc. when needed.

• Include any critical infrastructure or key resources damaged/destroyed/

impacted by the incident, the kind of infrastructure, and the extent of

damage and/or impact and any known cascading impacts.

• Refer to more specific or detailed damage assessment forms and

packages when they are used and/or relevant.

A. Structural Summary

Complete this table as needed based on the definitions for 30B–F below.

Note in table or in text block if numbers entered are estimates or are

confirmed. Summaries may also include impact to Shoreline and Wildlife,

etc.

B. # Threatened (72 hrs) Enter the number of structures potentially threatened by the incident within

the next 72 hours, based on currently available information.

C. # Damaged Enter the number of structures damaged by the incident.

D. # Destroyed Enter the number of structures destroyed beyond repair by the incident.

E. Single Residences Enter the number of single dwellings/homes/units impacted in Columns

30B–D. Note any specifics in the text block if needed, such as type of

residence (apartments, condominiums, single-family homes, etc.).

F. Nonresidential

Commercial Properties

Enter the number of buildings or units impacted in Columns 30B–D. This

includes any primary structure used for nonresidential purposes, excluding

Other Minor Structures (Block 30G). Note any specifics regarding building

or unit types in the text block.

Other Minor Structures Enter any miscellaneous structures impacted in Columns 30B–D not

covered in 30E–F above, including any minor structures such as booths,

sheds, or outbuildings.

Other Enter any miscellaneous issues which impacted Critical Infrastructure and

Key Resources.

Block

Number

Block Title Instructions

ADDITIONAL INCIDENT DECISION SUPPORT INFORMATION (PAGE 2)

*31 Public Status Summary

• This section is for summary information regarding incident-related

injuries, illness, and fatalities for civilians (or members of the public); see

31C–N below.

• Explain or describe the nature of any reported injuries, illness, or other

activities in Life, Safety, and Health Status/Threat Remarks (Block 33).

• Illnesses include those that may be caused through a biological event

such as an epidemic or an exposure to toxic or radiological substances.

• NOTE: Do not estimate any fatality information.

• NOTE: Please use caution when reporting information in this section that

may be on the periphery of the incident or change frequently. This

information should be reported as accurately as possible as a snapshot

in time, as much of the information is subject to frequent change.

• NOTE: Do not complete this block if the incident covered by the ICS 209

is not directly responsible for these actions (such as evacuations,

sheltering, immunizations, etc.) even if they are related to the incident.

o Only the authority having jurisdiction should submit reports for these

actions, to mitigate multiple/conflicting reports.

o For example, if managing evacuation shelters is part of the incident

operation itself, do include these numbers in Block 31J with any notes

in Block 33.

• NOTE: When providing an estimated value, denote in parenthesis: "est."

Handling Sensitive Information

• Release of information in this section should be carefully coordinated

within the incident management organization to ensure synchronization

with public information and investigative/intelligence actions.

• Thoroughly review the “Distribution” section in the introductory ICS 209

instructions for details on handling sensitive information. Use caution

when providing information in any situation involving fatalities, and verify

that appropriate notifications have been made prior to release of this

information. Electronic transmission of any ICS 209 may make

information available to many people and networks at once.

• Information regarding fatalities should be cleared with the Incident

Commander and/or an organizational administrator prior to submission of

the ICS 209.

A. # This Reporting

Period

Enter the total number of individuals impacted in each category for this

reporting period (since the previous ICS 209 was submitted).

B. Total # to Date

• Enter the total number of individuals impacted in each category for the

entire duration of the incident.

• This is a cumulative total number that should be adjusted each reporting

period.

C. Indicate Number of

Civilians (Public) Below

• For lines 31D–M below, enter the number of civilians affected for each

category.

• Indicate if numbers are estimates, for those blocks where this is an

option.

• Civilians are those members of the public who are affected by the

incident, but who are not included as part of the response effort through

Unified Command partnerships and those organizations and agencies

assisting and cooperating with response efforts.

D. Fatalities

• Enter the number of confirmed civilian/public fatalities.

• See information in introductory instructions (“Distribution”) and in Block

31 instructions regarding sensitive handling of fatality information.

Block

Number

Block Title Instructions

E. With Injuries/Illness Enter the number of civilian/public injuries or illnesses directly related to the

incident. Injury or illness is defined by the incident or jurisdiction(s).

*31

(continued)

F. Trapped/In Need of

Rescue

Enter the number of civilians who are trapped or in need of rescue due to

the incident.

G. Missing (note if

estimated)

Enter the number of civilians who are missing due to the incident. Indicate if

an estimate is used.

H. Evacuated (note if

estimated)

Enter the number of civilians who are evacuated due to the incident. These

are likely to be best estimates, but indicate if they are estimated.

I. Sheltering-in-Place

(note if estimated)

Enter the number of civilians who are sheltering in place due to the incident.

Indicate if estimates are used.

J. In Temporary Shelters

(note if estimated)

Enter the number of civilians who are in temporary shelters as a direct result

of the incident, noting if the number is an estimate.

K. Have Received Mass

Immunizations

Enter the number of civilians who have received mass immunizations due to

the incident and/or as part of incident operations. Do not estimate.

L. Require Mass

Immunizations (note if

estimated)

Enter the number of civilians who require mass immunizations due to the

incident and/or as part of incident operations. Indicate if it is an estimate.

M. In Quarantine Enter the number of civilians who are in quarantine due to the incident

and/or as part of incident operations. Do not estimate.

N. Total # Civilians

(Public) Affec

ted

Enter sum totals for Columns 31A and 31B for Rows 31D–M.

*32 Responder Status

Summary

• This section is for summary information regarding incident-related

injuries, illness, and fatalities for responders; see 32C–N.

• Illnesses include those that may be related to a biological event such as

an epidemic or an exposure to toxic or radiological substances directly in

relation to the incident.

• Explain or describe the nature of any reported injuries, illness, or other

activities in Block 33.

• NOTE: Do not estimate any fatality information or responder status

information.

• NOTE: Please use caution when reporting information in this section that

may be on the periphery of the incident or change frequently. This

information should be reported as accurately as possible as a snapshot

in time, as much of the information is subject to frequent change.

• NOTE: Do not complete this block if the incident covered by the ICS 209

is not directly responsible for these actions (such as evacuations,

sheltering, immunizations, etc.) even if they are related to the incident.

Only the authority having jurisdiction should submit reports for these