Hospital Incident Command System – Forms
For the documents below, select the (docx) version to download in Word format, select the (pdf) version to download in PDF format.
Download All HICS Forms (HICS Guidebook, Appendix H) In This One Document (docx) , (pdf)
Documents:
- HICS 200 – Incident Action Plan (IAP) Cover Sheet (docx) , (pdf)
- Incident Action Plan (IAP) Quick Start (docx) , (pdf)
- Epidemic-Pandemic: IRG (Incident Response Guide) (Updated) (docx) , (pdf)
- Epidemic-Pandemic: IPG (Incident Planning Guide) (Updated) (docx) , (pdf)
HICS Forms:
- HICS 201 – Incident Briefing (docx) , (pdf)
- HICS 202 – Incident Objectives (docx) , (pdf)
- HICS 203 – Organization Assignment List (docx) , (pdf)
- HICS 204 – Assignment List (docx) , (pdf)
- HICS 205A – Communications List (docx) , (pdf)
- HICS 206 – Staff Medical Plan(docx) , (pdf)
- HICS 207 – Hospital Incident Management Team (HIMT) Chart (docx) , (pdf)
- HICS 213 – General Message Form (docx) , (pdf)
- HICS 214 – Activity Log (docx) , (pdf)
- HICS 215A – Incident Action Plan (IAP) Safety Analysis (docx) , (pdf)
- HICS 221 – Demobilization Check-Out (docx) , (pdf)
- HICS 251 – Facility System Status Report (docx) , (pdf)
- HICS 252 – Section Personnel Time Sheet (docx) , (pdf)
- HICS 253 – Volunteer Registration (docx) , (pdf)
- HICS 254 – Disaster Victim/Patient Tracking (docx) , (pdf)
- HICS 255 – Master Patient Evacuation Tracking (docx) , (pdf)
- HICS 256 – Procurement Summary Report (docx) , (pdf)
- HICS 257 – Resource Accounting Record (docx) , (pdf)
- HICS 258 – Hospital Resource Directory (docx) , (pdf)
- HICS 259 – Hospital Casualty/Fatality Report (docx) , (pdf)
- HICS 260 – Patient Evacuation/Transfer Tracking Form (Updated 11/07/2021) (docx) , (pdf)
- HICS 260 – Patient Evacuation/Transfer Tracking Form Instructions (Updated 11/07/2021) (docx) , (pdf)
HICS
- HICS Basics Course
- HICS Incident Action Planning Course
- HICS Forms
- Incident Response Guide / Incident Planning Guide
- HICS Additional Information
HICS Templates and Examples
These templates are intended to serve only as samples for those new to HICS:
- HICS 201: Incident Briefing
- HICS 202: Incident Objectives Examples
- HICS 204: Assignment List Finance
- HICS 214: Activity Log
- HICS 2015A: Incident Action Plan IAP Safety Analysis
- HICS 2015A: Incident Action Plan IAP Safety Analysis
- Infection Disease Incident Planning Guide (IPG)
- Infection Disease Incident Response Guide (IRG)
- Hospital Seasonal influenza/Pandemic Preparedness Checklist
- HICS 201 Incident Briefing
- HICS 202 Incident Objectives
- HICS 203 Organization Assignment List
- HICS 204 Assignment List
- HICS 205A Communications List
- HICS 206 Staff Medical Plan
- HICS 207 Hospital Incident Management Team (HIMT) Chart
- HICS 213 General Message Form
- HICS 214 Activity Log
- HICS 215A Incident Action Plan (IAP) Safety Analysis
- HICS 221 Demobilization Check-Out
- HICS 251 Facility System Status Report
- HICS 252 Section Personnel Time Sheet
- HICS 253 Volunteer Registration
- HICS 254 Disaster Victim/Patient Tracking
- HICS 255 Master Patient Evacuation Tracking
- HICS 256 Procurement Summary Report
- HICS 257 Resource Accounting Record
- HICS 258 Hospital Resource Directory
- HICS 259 Hospital Casualty/Fatality Report
- HICS 260 Patient Evacuation Tracking
- The HICS Role Table Tents can be used during actual events or for exercises. They identify the name of each person filling the top nine roles.
- The tent cards act as a reminder of the Incident Action Planning Process and assist with completion of the appropriate forms.
- When it comes to completing The Joint Commission table top survey, TJC states that they want name plates/table tents with the role and name of person in the table top. This will also provide those personnel with a reminder on the role of that position and the Incident Action Planning Process.