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HICS 213 Incident Message Form

This document is an incident message form used by [hospital name] for emergency management to record messages received via phone, radio, or other means. The form includes fields to document the sender and receiver, date and time received, priority level, the message details, any actions taken, and routing information to forward the message to the appropriate parties. It provides a standardized method for documenting important communications during an incident response.

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Chris Smith
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107 views1 page

HICS 213 Incident Message Form

This document is an incident message form used by [hospital name] for emergency management to record messages received via phone, radio, or other means. The form includes fields to document the sender and receiver, date and time received, priority level, the message details, any actions taken, and routing information to forward the message to the appropriate parties. It provides a standardized method for documenting important communications during an incident response.

Uploaded by

Chris Smith
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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[hospital name]

Emergency Management
INCIDENT MESSAGE FORM
1. From (Sender) 2. To (Receiver)

3. Date Received 4. Time Received 5. Received Via 6. Reply Requested


Phone Radio Yes No
Other If yes, Reply to: (if different from Sender)

7. Priority
Urgent High Non Urgent Medium Informational Low

8. Message (Keep all messages/requests brief, to the point, and very specific)

9. Action taken (if any)

Received by: Time Received:

Comments:

Forward to:

Received by: Time Received:

Comments:

Forward to:

10. Facility Name

Purpose: Provide standardized method for recording messages received by phone or radio. HICS 213
Origination: All positions. Original to: Receiver Copies to: Documentation Unit Leader and Message Taker. Page 1 of 1

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