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HICS 213 Message Form Guide

The HICS 213 form is used to transmit messages regarding resource requests, status updates, and other coordination issues during an incident. It contains fields for the incident name, sender and recipient names and positions, subject, date, priority level, message text, approval if needed, and space for a reply. The form is initiated by any person on an incident and is used to ensure hard copies of messages are documented and replied to.

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David Mitchell
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121 views2 pages

HICS 213 Message Form Guide

The HICS 213 form is used to transmit messages regarding resource requests, status updates, and other coordination issues during an incident. It contains fields for the incident name, sender and recipient names and positions, subject, date, priority level, message text, approval if needed, and space for a reply. The form is initiated by any person on an incident and is used to ensure hard copies of messages are documented and replied to.

Uploaded by

David Mitchell
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HICS 213 - GENERAL MESSAGE FORM

1. Incident Name

2. To
PRINT NAME: _______________________________________________ POSITION: ____________________________________________________

3. From
PRINT NAME: _______________________________________________ POSITION: ___________________________________________________

4. Subject 5. Date 6. Time

7. Priority URGENT - HIGH NON URGENT - MEDIUM INFORMATIONAL - LOW

8. Message RESPONSE REQUIRED

9. Approved by PRINT NAME: _______________________________________ SIGNATURE:___________________________________________

10. Reply / Action Taken

11. Replied by PRINT NAME: ___________________________________________ SIGNATURE: _________________________________________

POSITION: ______________________________________________ FACILITY: ____________________________________________

DATE/TIME: _____________________________________________

Purpose: Used to transmit messages regarding resources requested, status information, and other coordination issues
Origination: Any personnel HICS 213 I Page 1 of 1
Copies to: Documentation Unit Leader
HICS 213 - GENERAL MESSAGE FORM

PURPOSE: The HICS 213 - General Message Form is used to record incoming messages that
cannot be orally transmitted to the intended recipients. The HICS 213 is also used to
transmit messages (resource order, status information, other coordination issues, etc.).
This form is used to send any message or notification to incident personnel that require
hard-copy delivery.

ORIGINATION: Initiated by any person on an incident.

COPIES TO: Upon completion, the HICS 213 is delivered to the original sender.

The HICS 213 is composed of three steps:


NOTES:  The message (Section 8) is completed by sender
 The message is replied to in Section 10
 After noting action taken, message form is returned to original sender

NUMBER TITLE INSTRUCTIONS


1 Incident Name Enter the name assigned to the incident.

2 To Enter the name and position for whom the message is intended.
For all individuals, use at least the first initial and last name.
For Unified Command, include agency names.

3 From Enter the name and position of the individual sending the
General Message. For all individuals, use at least the first initial
and last name. For Unified Command, include agency names.

4 Subject Enter the subject of the message.

5 Date Enter the date (m/d/y) of the message.

6 Time Enter the time (24-hour clock) of the message.

7 Priority Enter the priority of the message or request.

8 Message Enter the content of the message.

9 Approved by Enter the name and signature of the person approving the
message, if necessary.

10 Reply / Action Taken The intended recipient will enter a reply and/or action taken to
the message and return it to the originator.

11 Replied by Enter the name, signature of the person replying to the


message, and Hospital Incident Management Team (HIMT)
position. Enter date (m/d/y), time prepared (24-hour clock), and
facility.

HICS 2014

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