OSF Saint Francis Medical Center

Peoria, Illinois

Documents and Forms

HICS Forms
HICS-Incident Action Plan (IAP) Quick Start.docx (DOCX - 76.9 KB)
HICS-201 Incident Briefing.docx (DOCX - 125.7 KB)
HICS-201-Incident-Briefing.pdf (PDF - 417.6 KB)
HICS-202-Incident-Objectives.pdf (PDF - 414.2 KB)
HICS-203-Organization-Assignment.pdf (PDF - 412.5 KB)
HICS-204-Branch-Assignment-List.pdf (PDF - 411.8 KB)
HICS-205-Incident-Communication-Log.pdf (PDF - 442.1 KB)
HICS-206-Staff-Medical-Plan.pdf (PDF - 411.4 KB)
HICS-207-Organizational-Chart.pdf (PDF - 418.2 KB)
HICS-213-Incident-Message-Form.pdf (PDF - 413.7 KB)
HICS-214-Operational-Log.pdf (PDF - 410.5 KB)
HICS-251-Facility-System-Status-Report.pdf (PDF - 441.7 KB)
HICS-252-Section-Personnel-Time-Sheets.pdf (PDF - 411.0 KB)
HICS-253-Volunteer-Staff-Registration.pdf (PDF - 410.7 KB)
HICS-254-Disaster-Victim-Patient-Tracking-Form.pdf (PDF - 411.1 KB)
HICS-255-Master-Patient-Evacuation-Tracking-Form.pdf (PDF - 407.2 KB)
HICS-256-Procurement-Summary-Report.pdf (PDF - 407.0 KB)
HICS-257-Resource-Accounting-Record.pdf (PDF - 24.8 KB)
HICS-258-Hospital-Resource-Directory.pdf (PDF - 446.6 KB)
HICS 259 Hospital Casualty-Fatality Report.pdf (PDF - 24.9 KB)
HICS-260-Patient-Evacuation-Tracking-Form.pdf (PDF - 412.0 KB)
HICS-261-Incident-Action-Plan-Safety-Analysis.pdf (PDF - 410.3 KB)
Job Action Sheets
Incident Commander - JAS (PDF - 300.8 KB)
Public Information Officer - JAS (PDF - 73.0 KB)
Safety Officer - JAS (PDF - 71.8 KB)
Liason Officer - JAS (PDF - 69.4 KB)
Finance & Administration Section Chief - JAS (PDF - 76.1 KB)
Logistics Section Chief - JAS (PDF - 75.6 KB)
Operations Section Chief - JAS (PDF - 80.1 KB)
Planning Section Chief - JAS (PDF - 76.6 KB)
1135 Waiver
Requesting an 1135 Waiver.pdf (PDF - 65.1 KB)
EMTALA Waiver Toolkit.pdf (PDF - 71.5 KB)