HICS 258-Hospital Resource Directory



1. Incident Name2. Operational Period (# ) DATE: FROM: _________________________________________________ TO: _________________________________________________ TIME: FROM: _________________________________________________ TO: _________________________________________________3. Contact Information Company / Agency Company / Agency / Name(24/7 Contact)TelephoneAlternate TelephoneEmailFaxRadioAgency for Toxic Substances and Disease Registry (ATSDR)Air transport: helicopter orfixed wingAmbulance, hospital-basedAmbulance, privateAmbulance, public safetyAmerican Red CrossAutomated Teller Machine (ATM) (Onsite)Biohazard/Waste companyBusesCab (Taxi)Centers for Disease Control and Prevention (CDC)ClinicsCoroner/Medical ExaminerDispatcher, 911Emergency Management AgencyEMS Agency/AuthorityEmergency Operations Center (EOC), LocalEmergency Operations Center (EOC), StateCompany / Agency Company / Agency / Name(24/7 Contact)TelephoneAlternate TelephoneEmailFaxRadioEngineers: HVACEngineers: mechanicalEngineers: seismicEngineers: structuralEnvironmental Protection Agency (EPA)EpidemiologistFederal Bureau of Investigation (FBI)Fire DepartmentFood service (Note if vendor, onsite, or emergency)Fuel distributorFuel trucksFuneral homes/mortuary servicesGeneratorsHazMat TeamHealth department, localHealth department, stateHeavy equipment (e.g., backhoes, snowplow, etc.)Home health serviceHome repair/construction supplies1.pany / AgencyCompany / Agency / Name(24/7 Contact)TelephoneAlternate TelephoneEmailFaxRadioHospiceHospitalsHotel/motelHousing, temporaryIce, commercialLaboratory Response NetworkLaundry/linen serviceLaw EnforcementLightingLong term care facilitiesMedia: printMedia: printMedia: radioMedia: radioCompany / AgencyCompany / Agency / Name(24/7 Contact)TelephoneAlternate TelephoneEmailFaxRadioMedia: TVMedia: TVMedia: TVMedical gasesMedical supply1.2.Medication, distributorPharmacy, commercialPoison Control CenterPortable toiletsRadios: amateur radio Radios: satelliteRadios: handheld or 2-wayRegional Medical Health Coordinator Company / AgencyCompany / Agency / Name(24/7 Contact)TelephoneAlternate TelephoneEmailFaxRadioRepair Services BedsBiomedical devicesElevatorsGardeners/landscapersGlassMedical equipmentOxygen devicesRadios Roadways/sidewalksSalvation ArmyShelter SitesSurge FacilitiesTraffic Control/Department of TransportationTrucksRefrigerationTowingMovingUtilitiesGasCompany / AgencyCompany / Agency / Name(24/7 Contact)TelephoneAlternate TelephoneEmailFaxRadioUtilitiesGas/ElectricitySewageTelephone Water, municipalVending MachinesVentilatorsWater: non-potable Water: potableOtherOtherOtherOther4. Date Last Updated 5. Prepared by PRINT NAME: ____________________________________________________________________________ DATE/TIME: ______________________________________________________________________________ SIGNATURE: __________________________________________________________________________ facility: _____________________________________________________________________________Purpose:The HICS 258 - Hospital Resource Directory lists all methods of contact for hospital resources for an incident.origination:Completed by the Planning Section Resources Unit Leader prior to an incident (when possible) or at the incident onset, and continually updated throughout an incident. copies to:Distributed to the Command and General staff including the Documentation Unit Leader, and posted as necessary. Notes:If this form contains sensitive information such as cell phone numbers, it should be clearly marked in the header that it contains sensitive information and is not for public release.If additional pages are needed, use a blank HICS 258 and repaginate as needed. Additions and deletions may be made to the form to meet the organization’s needs.NUMBERTITLEINSTRUCTIONS1Incident NameEnter the name assigned to the incident.2Operational PeriodEnter the start date (m/d/y) and time (24-hour clock) and end date and time for the operational period to which the form applies.3Contact InformationCompany / AgencyType of company or pany / Agency / Name List the name of the company/agency. List the name of the point of contact if available.TelephoneEnter the telephone number.Alternate TelephoneEnter the alternate telephone number.EmailEnter the email, if available.FaxEnter the fax number.RadioEnter the radio frequency if appropriate.4Date Last UpdatedIf the document is completed prior to an incident, the last update should be entered (m/d/y). The directory should be updated at least annually.5Prepared byEnter the name and signature of the person preparing the form. Enter date (m/d/y), time prepared (24-hour clock), and facility. ................
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