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Appendix D.2: HICS Incident Action Plan (IAP)
QuickStart Guide
COMBINED HICS 201—202—203—204—215A
• PURPOSE: The Incident Action Plan (IAP) Quick Start is a short form combining HICS
Forms 201, 202,
203, 204 and 215A. It can be used in place of the full forms to
document initial actions taken
or during a short incident. Incident management can
expand to the full forms as needed.
• 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.
TITLE
INSTRUCTIONS
Incident Name
Enter the name assigned to the incident.
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.
Situation Summary
Enter brief situation summary.
Current Hospital Incident Management
Team
Enter the names of the individuals assigned to each position on
the Hospital Incident Management Team (HIMT) chart. 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.
Health and Safety Briefing
Summary of health and safety issues and instructions.
Incident Objectives
a. Objectives
b. Strategies/Tactics
c. Resources required
d. Assigned to
Enter each objective separately. Adjust objectives for
each operational period as needed. Document the
strategy/tactic, resources required, and who It was
assigned to.
APPENDIX D2: HICS INCIDENT ACTION PLAN QUICK START GUIDE
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TITLE
INSTRUCTIONS
Prepared by
Enter the name and signature of the person preparing the
form. Enter date (m/d/y), time prepared (24-hour clock),
and facility.
HICS INCIDENT ACTION PLAN (IAP) QUICK START
1.
Incident Name:
2.
Operational Period (#)
3.
Date:
4.
Situation Summary – HICS 201:
5.
Current Hospital Incident Management Team (fill in additional positions as appropriate):
HICS 201, 203:
6.
Health and Safety Briefing: Identify 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. HICS 202, 215A:
7.
Incident Objectives: HICS 202, 204:
8.
Objectives:
APPENDIX D2: HICS INCIDENT ACTION PLAN QUICK START GUIDE
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9.
Strategies/Tactics:
10.
Resources Required:
11.
Assigned to:
12.
Prepared By:
13.
Print name:
14.
Signature:
15.
Date/Time:
16.
Facility:
