homeland security

1. Incident Name:

2. Incident Number:

3. Date/Time Initiated: Date: Date Time: HHMM

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: Date

1. Incident Name:

2. Incident Number:

3. Date/Time Initiated: Date: Date Time: HHMM

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: Date

Incident Briefing (ICS 201) 1. Incident Name:

2. Incident Number:

3. Date/Time Initiated: Date: Date Time: HHMM

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

6. Prepared by:

Name:

Position/Title:

Signature:

ICS 201, Page 3

Date/Time: Date

1. Incident Name:

2. Incident Number:

3. Date/Time Initiated: Date: DateTime: HHMM

10. Resource Summary:

Resource

Resource Identifier

Date/Time Ordered

ETA

Arrived

Notes (location/assignment/status)

☐

6. Prepared by:

Name:

Position/Title:

Signature: _________________

ICS 201, Page 4

Date/Time: Date

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.

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.

1. Incident Name:

2. Operational Period:

Date From: Date

Date To: Date

Time From: HHMM

Time To: HHMM

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

☐ ICS 204 ☐ ICS 208

☐ ICS 205 ☐ Map/Chart

☐ ICS 205A ☐ Weather Forecast/Tides/Currents

☐ ICS 206 ☐ ___________________

Other Attachments:

☐ ___________________

☐ ___________________

☐ ___________________

☐ ___________________

7. Prepared by:

Name:

Position/Title:

Signature: ________________

8. Approved by Incident Commander:

Name:

Signature: ______________________

ICS 202

IAP Page

Date/Time: Date

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:

S pecific – Is the wording precise and unambiguous?

M easurable – How will achievements be measured?

A ction-oriented – Is an action verb used to describe expected accomplishments?

R ealistic – Is the outcome achievable with given available resources?

T 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).

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.