SampleICSformsforfinalproject.xlsx

Cover

Lincoln Propane Fire
Incident Action Plan
ICS-202 Response Objectives
ICS-203 Organization List
ICS-204 Assignment List
ICS-205 Communications Plan
ICS-206 Medical Plan
Map/Pictures
2/20/13
1115

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ICS 202

Incident Objectives 1. Incident Name 2. Date Prepared 3. Time Prepared
Lincoln Propane Fire 2/20/13 1115 am
4. Operational Period (Date and Time)
2/20/13 1130 am
5. General Control Objectives for the Incident (include Alternatives)
1 Ensure the safety of all responders and surrounding community
Mark Ethridge: Enter short, clear, concise statements of the objectives for managing the incident, including alternatives.
2 Evacuate surrounding community threatened by possible explosion
Mark Ethridge: Control objectives usually apply for the duration of the incident.
3 Establish perimeter around propane rail car and block all roadways 1 mile out in all directions
Mark Ethridge: Be sure to include objectives for the operational period!
4 Contain fire and cool propane rail car by water from fire trucks
5 Empty propane out of propane rail car
6 Resolve incident within a 48 hour timeframe
6. Weather Forecast for Operational Period
Sunny with no wind
7. General Safety Message
20 minute rotations for all fire personnel involved with containing fire with water trucks so no burns or high exposer to heat. Must evacuate surrounding communities within a 1 mile radius in case of explosion of propane rail car. Evacuation will remain in effect until threat is no longer there.
Mark Ethridge: Enter known Safety hazards and specific precautions for the operational period. Be sure to reference a specific safety message, form 223, if one is attached.
8. Attachments (check if attached)
ICS-202 9. Prepared by (PSC) 10. Approved by (IC)
John Smith

ICS 203

1. Incident Name Lincoln Propane Fire 9. Operations Section
2. Date 2/20/13 3. Time 1120 am Chief Austin Car
4. Operational Period 40537 Deputy
5. Incident Commander and Staff a. Branch I - Division/Groups
Incident Commander John Smith Branch Director
Deputy None Deputy
Safety Officer Mark Sorn Safety Group Mark Sorn
Information Officer Toby Black Task Force Group Tim Puckett
Liaison Officer Julie Tap Division/Group
6. Agency Representative Division/Group
Agency Name Division/Group
b. Branch II - Division/Groups
Branch Director
Deputy
Division/Group
Division/Group
Division/Group
Division/Group
Division/Group
C. Branch III - Division/Groups
Branch Director
Deputy
7. Planning Section Division/Group
Chief Mary Johnson Division/Group
Deputy Division/Group
Resource Unit E. Tibbit Division/Group
Situation Unit J. Jones Division/Group
Documentation Unit E. Abbot d. Air Operations Branch
Demobilization Unit S. Lensen Air Operations Branch Director None
Human Resources Air Support Supervisor
Technical Specialists (name / specialty) Air Attack Supervisor
T. Brown Fuels & Flammability Helicopter Coordinator
E. Stevens Metal Worker Air Tanker Coordinator
10. Finance Section
Chief
Deputy
8. Logistics Section Time Unit
Chief Tom Polar Procurement Unit
Deputy Comp/Claims Unit
Service Branch Dir. R. Dane Cost Unit
Support Branch Dir. A. Blitvich
Supply Unit
Facilities Unit
Ground Support Unit Prepared by E. Tibbit
Communications Unit C. Carter
Medical Unit A. Barrington
Security Unit A. Christy (Lincoln PD)
Food Unit D. Orrick

ICS 204

DIVISION ASSIGNMENT LIST 1. Branch 2. Division/Group
Safety
3. Incident Name 4. Operational Period
Lincoln Propane Fire Date: 2/20/13 Time: 1130
5. Operations Personnel
Operations Chief Austin Car Division/Group Supervisor Mark Sorn
Branch Director Air Attack Supervisor No.
6. Resources Assigned this Period
Strike Team/Task Force/Resource Designator Leader Number Persons Trans. Needed Drop Off PT./Time Pick Up PT./Time
Lincoln PD A.Christy 5 0
Lincoln Fire Department John Smith 6 0
Rocklin Fire Department A. Rice 6 0
7. Control Operations
Block all roads 1 mile out do not let any traffic in this zone. Escort evacuees out of danger zone.
Mark Ethridge: Provide a statement of the tactical objectives to be achieved within the operational period. Include any special instructions for individual resources.
Keep fire contained to propane rail car and keep the rail car cool by continuous cold water from water trucks.
8. Special Instructions
9. Division/Group Communication Summary
Mark Ethridge: This information is automatically filled from the 205.
Function System Grp/Channel Frequency Function System Grp/Channel Frequency
Command
Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: Provide a statement of the tactical objectives to be achieved within the operational period. Include any special instructions for individual resources.

Mark Ethridge: This information is automatically filled from the 205.
Support
Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: Enter statement calling attention to any safety problems or specific precautions to be exercised or other important information.
Group 25B
Prepared by (RESL) Approved by (PSC) Date Time
E. Tibbit M. Johnson 2/20/13 1130 am

ICS 204 2

DIVISION ASSIGNMENT LIST 1. Branch 2. Division/Group
Task Force Group
3. Incident Name 4. Operational Period
Lincoln Propane Fire Date: 2/20/13 Time: 1130
5. Operations Personnel
Operations Chief Austin Car Division/Group Supervisor Tim Puckett
Branch Director Air Attack Supervisor No.
6. Resources Assigned this Period
Strike Team/Task Force/Resource Designator Leader Number Persons Trans. Needed Drop Off PT./Time Pick Up PT./Time
Lincoln Water Trucks A. Gallion 3 0
Metal Works B. Lewis 4 0
Propane Trucks C. Foster 2 0
7. Control Operations
Water trucks to continuously spray cold water onto fiery propane rail car
Mark Ethridge: Provide a statement of the tactical objectives to be achieved within the operational period. Include any special instructions for individual resources.
Metal workers will cut hole in side of propane rail car to siphoned propane out. Propane trucks will take propane away.
8. Special Instructions
9. Division/Group Communication Summary
Mark Ethridge: This information is automatically filled from the 205.
Function System Grp/Channel Frequency Function System Grp/Channel Frequency
Command
Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: Provide a statement of the tactical objectives to be achieved within the operational period. Include any special instructions for individual resources.

Mark Ethridge: This information is automatically filled from the 205.
Support
Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: Enter statement calling attention to any safety problems or specific precautions to be exercised or other important information.
Group 26D
Prepared by (RESL) Approved by (PSC) Date Time
E. Tibbit M. Johnson 2/20/13 1130 am

ICS 204 3

DIVISION ASSIGNMENT LIST 1. Branch 2. Division/Group
4th Street Staging Area
3. Incident Name 4. Operational Period
Lincoln Propane Fire Date: 2/20/13 Time: 1130
5. Operations Personnel
Operations Chief Austin Car Division/Group Supervisor L. Murphy (STAM)
Branch Director Air Attack Supervisor No.
6. Resources Assigned this Period
Strike Team/Task Force/Resource Designator Leader Number Persons Trans. Needed Drop Off PT./Time Pick Up PT./Time
Lincoln Water Trucks A. Gallion 3 0
Metal Works B. Lewis 4 0
Propane Trucks C. Foster 2 0
Lincoln EMS Team C. Wilson 5 2 1200 1700
7. Control Operations
All resources remain in staging area and be prepared to respond within 10 minutes once notified of assignment by STAM.
Mark Ethridge: Provide a statement of the tactical objectives to be achieved within the operational period. Include any special instructions for individual resources.
8. Special Instructions
Be cognoscente of vehicles entering and exiting staging area.
Mark Ethridge: Enter statement calling attention to any safety problems or specific precautions to be exercised or other important information.
9. Division/Group Communication Summary
Mark Ethridge: This information is automatically filled from the 205.
Function System Grp/Channel Frequency Function System Grp/Channel Frequency
Command
Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: Provide a statement of the tactical objectives to be achieved within the operational period. Include any special instructions for individual resources.

Mark Ethridge: This information is automatically filled from the 205.
Support
Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: This information is automatically filled from the 205.

Mark Ethridge: Enter statement calling attention to any safety problems or specific precautions to be exercised or other important information.
Group 27A
Prepared by (RESL) Approved by (PSC) Date Time
E. Tibbit M. Johnson 2/20/13 1130 am

ICS 205

INCIDENT RADIO COMMUNICATIONS PLAN Incident Name Date/Time Prepared Operational Period Date/Time
Lincoln Propane Fire 2/20/13 1200 pm 2/20/13 1300 pm
4. Basic Radio Channel Utilization
Function Radio Type/Cache Group/Channel Frequency/Tone Assignment Remarks
Tactical
Mark Ethridge: Enter the function each channel number is assigned (i.e. command, support, division tactical, ground-to-air, etc.)
VHF Radio
Mark Ethridge: Enter the local system or radio cache system assigned and used on the incident. (e.g. 800mhz, Wolfforth, Lamb County, etc.)
25B
Mark Ethridge: Enter the radio call group and/or channel numbers assigned.
N/A
Mark Ethridge: If applicable, enter the frequency and tone numbers assigned to each specified function (e.g. 153.400/88.5) or (Tx: 154.000 Rx: 154.500/88.5)
Safety
Mark Ethridge: Enter the ICS organization assigned to each of the designated frequencies (e.g. Branch I, Division A).
Safety communications between all responders and safety officer
Mark Ethridge: This section should include narrative information regarding special situations.
Tactical
Mark Ethridge: Enter the function each channel number is assigned (i.e. command, support, division tactical, ground-to-air, etc.)

Mark Ethridge: Enter the local system or radio cache system assigned and used on the incident. (e.g. 800mhz, Wolfforth, Lamb County, etc.)
VHF Radio
Mark Ethridge: Enter the local system or radio cache system assigned and used on the incident.(e.g. 800mhz, Wolfforth, Lamb County, etc.)
26D
Mark Ethridge: Enter the radio call group and/or channel numbers assigned.
N/A
Mark Ethridge: If applicable, enter the frequency and tone numbers assigned to each specified function (e.g. 153.400/88.5) or (Tx: 154.000 Rx: 154.500/88.5)
Task Force Group
Mark Ethridge: Enter the ICS organization assigned to each of the designated frequencies (e.g. Branch I, Division A).
Allows for Communications w/water trucks, metal workers & propane trucks
Mark Ethridge: This section should include narrative information regarding special situations.
Operations
Mark Ethridge: Enter the function each channel number is assigned (i.e. command, support, division tactical, ground-to-air, etc.)

Mark Ethridge: Enter the local system or radio cache system assigned and used on the incident.(e.g. 800mhz, Wolfforth, Lamb County, etc.)

Mark Ethridge: Enter the radio call group and/or channel numbers assigned.
VHF Radio
Mark Ethridge: Enter the local system or radio cache system assigned and used on the incident.(e.g. 800mhz, Wolfforth, Lamb County, etc.)

Mark Ethridge: Enter the radio call group and/or channel numbers assigned.

Mark Ethridge: If applicable, enter the frequency and tone numbers assigned to each specified function (e.g. 153.400/88.5) or (Tx: 154.000 Rx: 154.500/88.5)
27A
Mark Ethridge: Enter the radio call group and/or channel numbers assigned.

Mark Ethridge: If applicable, enter the frequency and tone numbers assigned to each specified function (e.g. 153.400/88.5) or (Tx: 154.000 Rx: 154.500/88.5)

Mark Ethridge: Enter the ICS organization assigned to each of the designated frequencies (e.g. Branch I, Division A).
N/A
Mark Ethridge: If applicable, enter the frequency and tone numbers assigned to each specified function (e.g. 153.400/88.5) or (Tx: 154.000 Rx: 154.500/88.5)

Mark Ethridge: Enter the ICS organization assigned to each of the designated frequencies (e.g. Branch I, Division A).

Mark Ethridge: This section should include narrative information regarding special situations.
4th St Staging Area Manager
Mark Ethridge: Enter the ICS organization assigned to each of the designated frequencies (e.g. Branch I, Division A).

Mark Ethridge: This section should include narrative information regarding special situations.
4th Street Staging Area Communications
Mark Ethridge: This section should include narrative information regarding special situations.
Command VHF Radio 22C N/A Command/General Staff Incident Commander & supporting organizations
Tactical VHF Radio 23A N/A Police/Fire Communications between police and fire departments
5. Prepared by (Communications Unit)
C. Carter

ICS 206

Medical Plan Incident Name Date Prepared Time Prepared Operational Period
Lincoln Propane Fire 2/20/13 1200 pm 2/20/13 1300 pm
5. Incident Medical Aid Stations
Medical Aid Stations Location Paramedics
Yes No
BASE- Lincoln EMS Team BASE Area X
6. Transportation
A. Ambulance Services
Name Address Phone Paramedics
Yes No
Lincoln EMS 542 Fosket Ranch Road, Lincoln, CA 916-223-0110 X
B. Incident Ambulances
Name Location Paramedics
Yes No
Same as above
7. Hospitals
Name Address Travel Time Phone Helipad Burn Center
Air Grnd Yes No Yes No
Sutter Memorial Hospital 1 Medical Plaza Drive Roseville, CA 2 15 916-333-1111 X X
8. Medical Emergency Procedures
Transport any injured patients to BASE to get checked out by Lincoln EMS team/Paramedics on stand by. If Serious or life threatening injuries occur report them to BASE to be ground transported to Sutter Memorial Hospital immediately.
Mark Ethridge: Note any special emergency instructions for use by incident personnel. Be sure to include designated helicopter landing coordinates.
ICS-206 NFES 1331 Prepared by (Medical Unit Leader Reviewed by (Safety Officer)
A. Barrington Mark Sorn

ICS Map

SS  

B

Medical Plan (ICS 206)

Medical Plan (ICS 206)

Incident Map

Incident Map

Traffic Plan

Traffic Plan

Organization List (ICS 203)

Organization List (ICS 203)

Assignment List (ICS 204)

Assignment List (ICS 204)

Communications Plan (ICS 205)

Communications Plan (ICS 205)

Legend

Incident Location

Homes

Incident Command Post

Staging Area (4th St SA)

S

School Area

B

Lincoln Base

Legend

Incident Location

Homes

Incident Command Post

Staging Area (4

th

St SA)

School Area

Lincoln Base

S