HICS 251 – FACILITY SYSTEM STATUS REPORT

NOTE: The Winlink HICS 251 is an abbreviated version of the official form, focusing on overall facility status, i.e. the first page.
For the official form see here:
https://emsa.ca.gov/wp-content/uploads/sites/71/2017/07/HICS-251-Facility-System-Status-Report_4.pdf

PURPOSE
The HICS 251-Facility System Status Report is used to record the status of various critical facility systems and infrastructure. The HICS 251 provides the Planning and Operations Sections with information about current and potential system failures or limitations that may affect incident response and recovery.

ORIGINATION
Completed by the Operations Section Infrastructure Branch Director with input from facility personnel.

COPIES TO
Delivered to the Situation Unit Leader, with copies to the Operations Section Chief, Business Continuity Branch Director, Planning Section Chief, Safety Officer, Liaison Officer, Materiel Tracking Managers, and the Documentation Unit Leader.

NOTES
The Infrastructure Branch conducts the survey and correlates results. Individual department managers may also be tasked to complete an assessment of their areas and provide the information to the Infrastructure Branch. If additional pages are needed, use a blank HICS 251 and repaginate as needed. Additions and deletions may be made to the form to meet the
organization’s needs.

FIELDS

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 NAME OF FACILITY/REPORTING STATUS
Enter the name of the facility.

4 SYSTEM
System type listed in form.

5 STATUS
Fully functional: 100% operable with no limitations
Partially functional: Operable or somewhat operable with limitations
Nonfunctional: Out of commission
N/A: Not applicable, do not have

6 COMMENTS
Comment on location, reason, and estimates for necessary
repair of any system that is not fully operational. If inspection is
completed by someone other than as defined by policy or
procedure, identify that person in the comments.

7 REMARKS
Note any overall facility-wide assessments or future potential issues such as skilled staffing issues, fuel duration, plans for repairs, etc.

8 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.
_______________

The Winlink HICS 251 offers additional optional features to the standard form that allow the data to be mapped if coordinates are provided.
Moreover, there is an option to add the form data as a comma separated values (CSV) file for use in spreadsheets.

RADIO OPERATOR
Enter the name of the radio operator sending the form'

FACILITY LATITUDE and LONGITUDE
Enter the latitude and longitude or MGRS coordinates of the facility reporting.
This allows for the field data to be mapped within Winlink and GIS software packages, such as ArcGIS, QGIS, Google Maps, etc.

ATTACH CSV DATA FILE TO MESSAGE
Yes - attaches a comma separated values file to the message
No - does not attach a comma separated values file to the message

SAVE HICS251 DATA
Saves a copy of the form entries to a text (TXT) file, which can be loaded using the LOAD HICS251 DATA function at the top of the form.
This is useful when the originator and the sender are different people.

RESET FORM
Clears all entries from the form.

SUBMIT
Sends the form data to the Winlink message.

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Copy and Paste Data From Spreadsheet

Copy the data from the spreadsheet, then click the button "Parse Data"
TAB delineation and entry data needs to not exceed HTML entry box input lengths.
10 columns and up to 10 rows of information.

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HICS 251 – FACILITY SYSTEM STATUS REPORT
  HICS - Hospital Incident Command System

 


   1. Incident Name  

      Page  Of       
  
  2. Operational Period    (#):  

         Date From      To  

         Time From         To  
  3. Name of Department / Unit Reporting Status Below          Contact Number:
4. System 5. Status 6. Comments If not fully functional, give location, reason, and estimated time/resources for necessary repair. Identify who reported or inspected.
4a. Power
4b. Lighting
4c. Water
4d. Sewage/Toilets
4e. Nurse Call System
4f. Medical Gases / Oxygen
4g. Communications IT system, telephones, pagers
7. Remarks (Cracked walls, broken glass, falling light fixtures, etc.)
8. Prepared By:      Date / Time:   FACILITY :    

  Radio Operator        Name:

    Facility Latitude and longitude: LAT    LON  MGRS   Grid       
    LAT/LON and MGRS default to the center of the grid square listed in Express Settings,  unless a GPS is used or Lat/LON  or MGRS must be entered
    manually.
  Without properly formatted GPS coordinates this form cannot be mapped in Winlink Express.

     Attach CSV data file to message? Yes    No  
    

 
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