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