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Emergency Preparedness

Activation Forms

Responding to a Disaster

During a Department Operations Center (DOC) activation, complete the relevant forms and e-mail them to: HSADoc@santacruzcounty.us

Use Adobe Acrobat to fill out the forms. Other programs (including the Microsoft Edge web browser) may not save data or support the 'Email Now' function that is located on each form.

If you have trouble emailing, fax to (831) 454-5068 or (831) 454-4488. Call the DOC with any questions at (831) 454-4444.

Situation Status Forms

Situation Status Form (PHDOC-01)
Report general facility status to Emergency Preparedness and Response.

Download

Resource Request Forms

Resource Request Form - Supplies and Equipment (PHDOC-02)
Submit a request for additional supplies in the event of an emergency.

Download

Resource Request Form - Personnel (PHDOC-03)
Submit a request for additional staffing support with this form. See a list of all available MRC volunteer categories.

Download

Capacity Assistance Forms

Assistance Capacity Report for Clinics (PHDOC-04)
Report facility hours, service expansion capabilities, or your organization’s ability to support additional services, if requested.

Download

Assistance Capacity Report for Surgery Centers (PHDOC-05)
Report facility hours, service expansion capabilities, or your organization’s ability to support additional services, if requested.

Download

Assistance Capacity Report for Skilled Nursing Facilities (SNFs) and Long-term Care Facilities (LTCFs) (PHDOC-06)
Report facility hours, service expansion capabilities, or your organization’s ability to support additional services, if requested.

Download

Patient Tracking Forms

HICS 255 Master Patient Evacuation Tracking Form

Download

HICS 260 Patient Evacuation Tracking Form

Download

Instructions & Exercise Forms

Instructions for use of PH DOC 01, 02, and 03:

Instructions

ICS 214 Unit Log
Document all of your facility’s response activities in the event of a disaster.

Download