Incident Action Plan (IAP)

1. Incident Name / 2. OperationalPeriod (#)
DATE: FROM:_ TO:_

TIME:FROM:TO:
3.Attachments The items checked below are included in this Incident Action Plan (IAP)
Incident Action Plan (IAP) Quick Start or
HICS 201 - IncidentBriefing
HICS 202 - IncidentObjectives
HICS 203 - Organization AssignmentList
HICS 204 - AssignmentList
HICS 204-AssignmentList;Operations Section:Staging
HICS204-AssignmentList;OperationsSection:MedicalCareBranch
HICS 204-AssignmentList;Operations Section:InfrastructureBranch
HICS204-AssignmentList;OperationsSection:SecurityBranch
HICS 204 - Assignment List; Operations Section:HazMat Branch
HICS204-AssignmentList;OperationsSection:BusinessContinuityBranch
HICS 204 - Assignment List; Operations Section: Patient Family AssistanceBranch
HICS 204-AssignmentList;PlanningSection
HICS 204-AssignmentList;LogisticsSection:ServiceBranch
HICS204-AssignmentList;LogisticsSection:SupportBranch
HICS 204-AssignmentList;Finance/AdministrationSection
HICS 215A - Incident Action Plan (IAP) SafetyAnalysis
Other: _ Other: Other: _ Other: _
4. Prepared by / PRINTNAME: / SIGNATURE: / _
Planning Section Chief
DATE/TIME: / FACILITY:
5. Approved by / PRINTNAME: / _ / SIGNATURE:
Incident Commander
DATE/TIME: / FACILITY:

Purpose:ProvidecoversheetandchecklistforHICSFormsandotherdocumentsincludedintheOperationalPeriod

Incident Action Plan (IAP)

Origination:Incident Commander or Planning SectionChief

Copiesto:Command Staff, Section Chiefs, and Documentation UnitLeader

HICS 200 | Page 1 of 1

PURPOSE:The HICS 200 – Incident Action Plan (IAP) Cover Sheet provides a cover sheetandachecklist for HICS Forms and other documents included in the operational period IAP.

ORIGINATION:Prepared by the Incident Commander or Planning Section Chief.

COPIESTO:Duplicated and distributed to Command and General Staff positions activated.Allcompletedoriginal forms must be given to the Documentation UnitLeader.

NOTES:Ifadditional pagesareneeded foranyformpage,useablankHICS 200andrepaginate asneeded. Additions may be made to the form to meet the organization’sneeds.

NUMBER / TITLE / INSTRUCTIONS
1 / Incident Name / Enter the name assigned to the incident.
2 / Operational Period / Enter 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.
3 / Attachments / Check or list all HICS Forms and other documents that are included in the Incident Action Plan(IAP).
4 / Prepared by
Planning Section Chief / Enter the name and signature of the person preparing the form. Enter date (m/d/y), time prepared (24-hour clock), and facility.
5 / Approved by Incident Commander / Enter the name and signature of the person approving the form. Enter date (m/d/y), time prepared (24-hour clock), and facility.

HICS 2014