ࡱ> #` Hbjbj <AWl l l l  YYY8YlZ< 8[@^(____ ` `$h@du !`__!`!`l l __Zccc!`jl _ _c!`cc7`@ T _[ p{"Y`^\#p0` 4!`!`c!`!`!`!`!`bj!`!`!`!`!`!`!` (3$& 3 l l l l l l   ICS 201 Incident Briefing Form  Purpose: When to fill out: Completed by: Approved by: Send to:How to use this form: Documents the situation and objectives determined by the IDER Commander, Command and General staff during the Activation and Notification Conference. At the start of the FIRST Operational Period CDCP on-call physician IDER Commander All responders as a component of the Incident Action Plan for the FIRST operational period ONLY This form has multiple pages please check that all are duplicated!1. Date  FORMTEXT      2. Time  FORMTEXT      3. Operational Period:  FORMTEXT      4. Prepared by: Name:  FORMTEXT       Position: CDCP on-call physician5. Approved by: Name:  FORMTEXT       Position:  FORMTEXT      6. Situation Summary Event summary:  FORMTEXT       Statistics: # confirmed cases:  FORMTEXT       # suspected cases:  FORMTEXT       Estimated extent / # exposed:  FORMTEXT       # hospitalized:  FORMTEXT       # given treatment / prophylaxis:  FORMTEXT       Duration: Anticipated duration of situation:  FORMTEXT       days / weeks / months / unknown Anticipated duration of the infectious disease emergency (IDE) response:  FORMTEXT       days / weeks / months / unknown 7. Summary of Current Actions Taken:  FORMTEXT       8. Objectives and tasks for the Initial Operational Period: Objectives Tasks for each objective  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       9. Other agencies involved:  FORMTEXT       10. Modules and Staff required for the Response: Activate* Module Recommended Staff Total # Staff ( ( ( ( ( IDER Command Incident Commander Liaison Officer Safety Officer Information Officer Field Officer __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ ( ( ( ( ( ( Plans Section Situation Status Unit Resource Status Unit Documentation Unit Technical Specialist Unit Demobilization Unit __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Operations Section Epidemiology & Surveillance Branch Investigation Group Surveillance Group Laboratory Branch Laboratory Testing Group Lab Resources Management Group Disease Containment Branch Infection Control Group Restriction, Exclusion, & Clearance Group Mass Prophylaxis Group Isolation and Quarantine Group Communicable Disease Information Branch Information Triage Group Information Content Creation Group Information Dissemination Group Data Branch Data Analysis Group Application Support Group Continuity of Operations Branch __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ 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Finance Section Procurement Unit Cost Unit Time Tracking Unit __________________________________________ __________________________________________ __________________________________________ __________________________________________ * Pre-checked boxes indicate modules/positions that should be activated for every response11. 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