Disaster Information Report - City of South Pasadena
This form is used for taking reports from field personnel and / or the general public
Incident address: (*)
{var IncdAddress}
Facility/building name: (*)
{var IncdFacility}
Description of problem: (*)
{var DescProblem}
Priority:
Critical/life safety
{var PriorCritical}
Urgent
{var PriorUrgent}
Routine
{var PriorRoutine}
Damage reported by:
{var ReportBy}
Agency/dept: phone #:
{var AgencyDept}
Incident type:
{var IncdType}
Damage report date: (*)
{var DateReported}
Report time: (*)
{var TimeReported}
Damage report taken by:
{var TakenBy}
EOC position:
{var EOCPos}
Requires response?
{var ReqResp}
Then send to operations
Information only?
{var InfoOnly}
Then send to planning
Action taken:
{var ActTaken}
Follow up needed:
{var FollowUp}
Comments: (*)
{var InpComm}
Originator: Any EOC/DOC position. Retain Copy
Routing: Appropriate OPS section for response, Ops to retain copy. Then send to Situation Status (Plans/Intel Section)
For major incidents, information in boxes marked with this symbol (*) needs to be posted to the appropriate Status Board