HICS 200 - INCIDENT ACTION PLAN (IAP) COVER SHEET
HICS 200 | Page 1 of 1
Purpose: Provide cover sheet and checklist for HICS Forms and other documents included in the Operational Period
Incident Action Plan (IAP)
Origination: Incident Commander or Planning Section Chief
Copies to: Command Staff, Section Chiefs, and Documentation Unit Leader
1. Incident Name
2. Operational Period (# )
DATE: FROM: ________________________ TO: _______________________
TIME: FROM: ________________________ TO: _______________________
3. Attachments The items checked below are included in this Incident Action Plan (IAP)
❑ Incident Action Plan (IAP) Quick Start
or
❑ HICS 201 - Incident Briefing
❑ HICS 202 - Incident Objectives
❑ HICS 203 - Organization Assignment List
❑ HICS 204 - Assignment List
❑ HICS 204 - Assignment List; Operations Section: Staging
❑ HICS 204 - Assignment List; Operations Section: Medical Care Branch
❑ HICS 204 - Assignment List; Operations Section: Infrastructure Branch
❑ HICS 204 - Assignment List; Operations Section: Security Branch
❑ HICS 204 - Assignment List; Operations Section: HazMat Branch
❑ HICS 204 - Assignment List; Operations Section: Business Continuity Branch
❑ HICS 204 - Assignment List; Operations Section: Patient Family Assistance Branch
❑ HICS 204 - Assignment List; Planning Section
❑ HICS 204 - Assignment List; Logistics Section: Service Branch
❑ HICS 204 - Assignment List; Logistics Section: Support Branch
❑ HICS 204 - Assignment List; Finance/Administration Section
❑ HICS 215A - Incident Action Plan (IAP) Safety Analysis
Other: ________________________________________________________________________________________________________________________________
Other: ________________________________________________________________________________________________________________________________
Other: ________________________________________________________________________________________________________________________________
Other: ________________________________________________________________________________________________________________________________
4. Prepared by
Planning Section Chief
PRINT NAME: _______________________________________
DATE/TIME: _________________________________________
SIGNATURE: _____________________________________________
FACILITY: ________________________________________________
5. Approved by
Incident Commander
PRINT NAME: _______________________________________
DATE/TIME: _________________________________________
SIGNATURE: _____________________________________________
FACILITY: ________________________________________________
HICS 200 - INCIDENT ACTION PLAN (IAP) COVER SHEET
HICS 2014
PURPOSE: The HICS 200 – Incident Action Plan (IAP) Cover Sheet provides a cover sheet and a
checklist for HICS Forms and other documents included in the operational period IAP.
ORIGINATION: Prepared by the Incident Commander or Planning Section Chief.
COPIES TO: Duplicated and distributed to Command and General Staff positions activated. All completed
original forms must be given to the Documentation Unit Leader.
NOTES: If additional pages are needed for any form page, use a blank HICS 200 and repaginate as
needed. Additions may be made to the form to meet the organization’s needs.
NUMBER
TITLE
INSTRUCTIONS
1
Incident Name
Enter the name assigned to the incident.
2
Operational Period
Enter the start date (m/d/y) and time (24-hour clock) and end date
and time for the operational period to which the form applies.
3
Attachments
Check or list all HICS Forms and other documents that are included
in the Incident Action Plan (IAP).
4
Prepared by
Planning Section Chief
Enter the name and signature of the person preparing the form. Enter
date (m/d/y), time prepared (24-hour clock), and facility.
5
Approved by
Incident Commander
Enter the name and signature of the person approving the form.
Enter date (m/d/y), time prepared (24-hour clock), and facility.
