Incident Status Summary (ICS-209)

*1: Incident Name
Hurricane Test		 2: Incident Number:
1234
*3: Report Version: (check one box on left):

Initial

Update

Final
Rpt# (if used):
*4: Incident Commander(s) & Agency or Organization:
5: Incident Management Organization:
6: Incident Start Date/Time
Date: 2011-08-02

Time: 01:18

Time Zone: -06:00
7: Current Incident Size or Area Involved (use unit label -- eg., "sq mi," "city block"):
22		8. Percent (%) Contained
9
Completed

*9. Incident Definition:
Hurricane		*10. Incident Complexity Level:
Very Complex		*11. For Time Period:
From Date/Time:2011-08-02/01:18

To Date/Time: 2011-08-02/01:18
Approval & Routing Information
*12: Prepared By:
Print Name: James Smith ICS Position:

Date/Time Prepared: 2011-08-02/01:18		*13: Date/Time Submitted:
Time Zone:
*14: Approved By:
Print Name: John Doe ICS Position:

Date/Time Prepared: 2011-08-02/01:18		*15: Primary Location, Organization, or Agency Sent To:
Incident Location Information
*16. State: *17. County/Parish/Borough:*18. City:
19. Unit or Other: *20. Incident Jurisdiction: 21. Incident Location Ownership
(if different than jurisdiction)
22. Longitude (indicate format):

Latitude (indicate format): 		23. US National Grid Reference:24. Legal Description (township, section, range):
*25. Short Location or Area Description (list all affected areas or a reference point):26. UTM Coordinates:
27. Note any electronic geospatial data included or attached (indicate data format, content, and collection time information and labels):
Incident Summary
*28. Significant Events for the Time Period Reported: (summarize significant progress made, evacuations, incident growth, etc.):

*29 Primary Materials or Hazards Involved (hazardous chemicals, fuel types, infectious agents, radiation, etc):
Possible Disease outbreak
30. Damage Assesment Information (summarize damage and/or restriction of use or availability to residential or commercial property, natural resources, critical infrastructure and key resources, etc.):

Damage is severe
A. Structural SummaryB. # Threatened (72 hrs) C. # Damaged D. # Destroyed
E. Single Residences555
F. Nonresidential Commerical Property 555
Other minor Structures
Other555
Additional Incident Decision Support Information-
*31. Public Status Summary:A. # This Reporting Period B. Total # to Date
C. Indicate Number of Civilians (Public Below):
D.Fatalities
E. With Injuries/Illness
F. Trapped/In Need of Rescue
G. Missing (note if estimated)
H. Evacuated (note if estimated)
I. Sheltering in Place (note if est)
J. In Temporary Shelters (note if est.)
K. Have Recieved Mass immunizations
L. Require Immunizations (note if est.)
M. In Quarantine
N. Total # Civilians (Public) Affected: 2244
*32. Responder Status Summary:A. # This Reporting Period B. Total # to Date
C. Indicate Number of Civilians (Public Below):
D.Fatalities
E. With Injuries/Illness
F. Trapped/In Need of Rescue
G. Missing
H. Sheltering in Place
I. Have Received Immunizations
J. Require Immunizations
K. In Quarantine
N. Total # Civilians (Public) Affected: 1233
33. Life, Safety, and Health Status/Threat Remarks:

humans can die
34. Life, Safety, and Health Threat Management:A. Check if Active
A. No Likely Threat
B. Potential Future Threat
C. Mass Notificatoins in Progress
D. Mass Notifications Completed
E. No Evacuation(s) Imminent
F. Planning for Evacuation
G. Planning for Shelter-In-Place
H. Evacuation(s) in Progress
I. Shelter-in-Place in Progress
J. Repopulation in Progress
K. Mass Immunizatoin in Progress
L. Mass Immunization Complete
M. Quarantine in Progress
N. Area Restrction in Effect
35. Weather concerns (synopsis of current and predicted weather, discuss related factors that may caues concern);

Secondary flooding damage
36. Projected Incident Activity, Potential, Movement, Escalation, or Spread and influencing factors during the next operational period and in 12-,24-,48-,and 72-hour timeframes


12 hours:Treat and transport a

24 hours:

48 hours:

72 hours:

Anticipated After 72 hours:
37. Strategic Objectives (defined planned end-state for incident):
38. Current Incident Threat Summary and Risk Information in 12-, 24-,48-, and 72-hour timeframes and beyond. Summarize primary incident threats to life, property, communities and community stability, residences, health care facilities, other critical infrastructure and key resources, commercial facilities, natural and environmental resources, cultural resources, and continuity of operations and/or business. Identify corresponding incidentrelated potential economic or cascading impacts.


12 hours:

24 hours:

48 hours:

72 hours:

Anticipated After 72 hours:
39. Critical Resource Needs in 12-, 24-, 48-, and 72-hour timeframes and beyond to meet critical incidente objectives. List resource category, kind, and/or type, and amount needed, in priority order:


12 hours:Type I ALS Ambulances

24 hours:Type II ALS Ambulances

48 hours:Type III ALS Ambulances

72 hours:Type IV ALS Ambulances

Anticipated After 72 hours:Type V ALS Ambulance
40. Strategic Discussion: Explain the relation of overall strategy, constraints, and current available information to:
1) critical resource needs identified above,
2) the Incident Action Plan and magement objectives and targets,
3) anticipated results.

Explain major problems and concerns such as operational challenges, incident management problems, and social, political, economic, or enviromental concerns or impacts.

Need to evac patients
41. Planned Actions for Next Operational Period:Continue Triage and Treatment
42. Projected Final Incident Size/Area(use unit label -- e.g., "sq mi"): 1
43. Anticipated Incident Management Completion Date:(use unit label -- e.g., "sq mi"): 2011-08-02
44. Projected Significant Resource Demobilization Start Date:
45. Estimated Incident Costs to Date:10.00 DOL
46. Projected Final Incident Cost Estimate:10.00 DOL
47. Remarks(or continuation of any blocks above -- list block number in notation):
Incident Resource Commitment Summary
48. Agency or Organization
49. Resources (summarize resources by category, kind, and/or type: show # of resources on top 1/2 of box, show # of personnel associated with resource on bottom 1/2 of box):
50. Additional Personnel not assigned to a resource:
51. Total Personnel (includes those associated with resources -e.g., airraft or engines and individual overhead):
FEMA
Wood2
 
FEMA
Water2
 
FEMA
Plastic Tarps2
 
FEMA
Sheeting2
 
State EOC
Wood2
 
State EOC
Water2
 
State EOC
Plastic Tarps2
 
State EOC
Sheeting2
 
                     
                     
53. Additional Cooperating and Assisting Organizations Not Listed Above: