Exercise Evaluation Guide Template (EEG) - NWHRN



Exercise Evaluation Guide (EEG)Exercise Name: [Insert exercise name]Exercise Date: [Insert exercise date]Organization:[Insert facility name]ResponseExercise Objective 1: Facility staff activate and implement their facility emergency operations plan.HPP Capability 2: Health Care and Medical Response CoordinationHPP Capability Goal: Health care organizations, the health care coalition, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events.Capability Target 1: Facility staff activate and implement their facility emergency operations plan.Critical Task: Facility staff activate their facility emergency operations plan immediately after simulated shaking stops.Source(s): 2017-2022 Health Care Preparedness and Response Capabilities; [Insert name of your facility’s emergency operations plan, and list other applicable plans, policies, procedures, or references]Capability TargetCritical TasksObservation Notes andExplanation of RatingTarget RatingFacility staff activate and implement the facility emergency operations plan. Facility staff activate the facility emergency operations plan immediately after simulated shaking stops.Final Capability RatingRatings KeyP – Performed without challengesS – Performed with some challengesM – Performed with major challengesU – Unable to be performed Evaluator Name Evaluator E-mail Phone Exercise Name: [Insert exercise name]Exercise Date: [Insert exercise date]Organization:[Insert facility name]ResponseExercise Objective 2: Facility staff are trained and can make a determination regarding the facility operating status following an earthquake.HPP Capability 3: Continuity of Health Care Service DeliveryHPP Capability Goal: Health care organizations, with support from the health care coalition and ESF-8 lead agency, provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery result in a return to normal or, ideally, improved operations.Capability Target 1: Staff conduct preliminary damage assessment of the facility.Critical Task: Responsible parties demonstrate familiarity of factors which may be considered when conducting a preliminary damage assessment of your facility following an earthquake.Critical Task: Responsible parties conduct an accountability check of all staff and patients/residents present at the facility following an earthquake.Critical Task: Responsible parties determine any facility resource needs resulting from a facility disruption.Source(s): 2017-2022 Health Care Preparedness and Response Capabilities; [Insert name of your facility’s emergency operations plan, and list other applicable plans, policies, procedures, or references]Capability Target 2: Facility leadership make determination regarding the facility operating status.Critical Task: Facility leadership make determination whether facility should evacuate, shelter-in-place, or operate as normal following an earthquake.Source(s): 2017-2022 Health Care Preparedness and Response Capabilities; [Insert name of your facility’s emergency operations plan, and list other applicable plans, policies, procedures, or references]Capability TargetCritical TasksObservation Notes andExplanation of RatingTarget RatingStaff conduct preliminary damage assessment of the facility. Responsible parties demonstrate familiarity of factors which may be considered when conducting a preliminary damage assessment of your facility following an earthquake.Staff conduct preliminary damage assessment of the facility.Responsible parties conduct an accountability check of all staff and patients/residents present at the facility following an earthquake.Staff conduct preliminary damage assessment of the facility.Responsible parties determine any facility resource needs resulting from a facility disruption.Facility leadership make determination regarding the facility operating status.Facility leadership make determination whether facility should evacuate, shelter-in-place, or operate as normal following an earthquake.Final Capability RatingRatings KeyP – Performed without challengesS – Performed with some challengesM – Performed with major challengesU – Unable to be performed Evaluator Name Evaluator E-mail Phone Exercise Name: [Insert exercise name]Exercise Date: [Insert exercise date]Organization:[Insert facility name]ResponseExercise Objective 3: Facility staff are trained and, following a facility emergency operations plan activation, can communicate facility operating status to all staff.HPP Capability 2: Health Care and Medical Response CoordinationHPP Capability Goal: Health care organizations, the health care coalition, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events.Capability Target 1: Facility notifies staff working in the facility of the facility operating status following activation of the emergency operations plan.Critical Task: Responsible parties notify all staff working within the facility of the facility operating status following activation of the emergency operations plan.Source(s): 2017-2022 Health Care Preparedness and Response Capabilities; [Insert name of your facility’s emergency operations plan, and list other applicable plans, policies, procedures, or references]Capability Target 2: Facility notifies patients/residents of the facility operating status following activation of the emergency operations plan.Critical Task: Responsible parties notify all patients and residents of the facility operating status following activation of the emergency operations plan.Source(s): 2017-2022 Health Care Preparedness and Response Capabilities; [Insert name of your facility’s emergency operations plan, and list other applicable plans, policies, procedures, or references]Organization:[Insert facility name]Capability TargetCritical TasksObservation Notes andExplanation of RatingTarget RatingFacility notifies staff working in the facility of the facility operating status following activation of the emergency operations plan.Responsible parties notify all staff working within the facility of the facility operating status following activation of the emergency operations plan.Facility notifies patients/residents of the facility operating status following activation of the emergency operations plan.Responsible parties notify all patients and residents of the facility operating status following activation of the emergency operations plan.Final Capability RatingRatings KeyP – Performed without challengesS – Performed with some challengesM – Performed with major challengesU – Unable to be performed Evaluator Name Evaluator E-mail Phone Exercise Name: [Insert exercise name]Exercise Date: [Insert exercise date]Organization:[Insert facility name]ResponseExercise Objective 4: Facility staff are trained and, following a facility emergency operations plan activation, can communicate facility operating status to patients, the public, and health care partners.HPP Capability 2: Health Care and Medical Response CoordinationHPP Capability Goal: Health care organizations, the health care coalition, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events.Capability Target 1: Facility notifies out-of-office staff of the facility operating status following activation of the emergency operations plan.Critical Task: Responsible parties notify staff located outside of the facility of the facility operating status following a disruption.Critical Task: Responsible parties provide out-of-office staff with further instructions on how to support the facility operating status.Source(s): 2017-2022 Health Care Preparedness and Response Capabilities; [Insert name of your facility’s emergency operations plan, and list other applicable plans, policies, procedures, or references]Capability Target 2: Facility notifies patient/resident families of the facility operating status following activation of the emergency operations plan.Critical Task: Responsible parties notify patient/resident families of the facility operating status.Source(s): 2017-2022 Health Care Preparedness and Response Capabilities; [Insert name of your facility’s emergency operations plan, and list other applicable plans, policies, procedures, or references]Capability Target 3: Facility notifies the public of the facility operating status following activation of the emergency operations plan.Critical Task: Responsible parties notify the public of the facility operating status.Critical Task: Responsible parties notify the Northwest Healthcare Response Network of the facility operating status.Source(s): 2017-2022 Health Care Preparedness and Response Capabilities; [Insert name of your facility’s emergency operations plan, and list other applicable plans, policies, procedures, or references]Capability TargetCritical TasksObservation Notes andExplanation of RatingTarget RatingFacility notifies out-of-office staff of the facility operating status following activation of the emergency operations plan.Responsible parties notify staff located outside of the facility of the facility operating status following a disruptionFacility notifies out-of-office staff of the facility operating status following activation of the emergency operations plan.Responsible parties provide out-of-office staff with further instructions on how to support the facility operating status.Facility notifies patient/resident families of the facility operating status following activation of the emergency operations plan.Responsible parties notify patient/resident families of the facility operating status.Facility notifies the public of the facility operating status following activation of the emergency operations plan.Responsible parties notify the public of the facility operating status.Facility notifies the public of the facility operating status following activation of the emergency operations plan.Responsible parties notify the Northwest Healthcare Response Network of the facility operating status.Final Capability RatingRatings KeyP – Performed without challengesS – Performed with some challengesM – Performed with major challengesU – Unable to be performed Evaluator Name Evaluator E-mail Phone Ratings DefinitionsPerformed without Challenges (P)The targets and critical tasks associated with the capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws.Performed with Some Challenges (S)The targets and critical tasks associated with the capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. However, opportunities to enhance effectiveness and/or efficiency were identified.Performed with Major Challenges (M)The targets and critical tasks associated with the capability were completed in a manner that achieved the objective(s), but some or all of the following were observed: demonstrated performance had a negative impact on the performance of other activities; contributed to additional health and/or safety risks for the public or for emergency workers; and/or was not conducted in accordance with applicable plans, policies, procedures, regulations, and laws.Unable to be Performed (U)The targets and critical tasks associated with the capability were not performed in a manner that achieved the objective(s). ................
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