RO HEMS FORM 2 –EVENT NAME- REF#

Republic of the Philippines

Department of Health
Regional Office 02
HEALTH EMERGENCY MANAGEMENT STAFF
REPORTING UNIT: RHU San Guillermo

RAPID HEALTH ASSESSMENT

As of (mm/dd/yyyy): _October 21,2020_
Event: _TROPICAL DEPRESSION PEPITO__

Purpose: To determine the magnitude of an emergency and the health needs and capacity of the affected area/s to cope.
Instructions: This form shall be submitted within 24 hours upon occurrence of major emergency or disaster.
Complete all the necessary fields. Please attach photos if available.

A. EVENT INFORMATION
Type of Hazard
NATURAL BIOLOGICAL TECHNOLOGICAL SOCIETAL
󠄀Monsoon Rains 󠄀Lightning 󠄀Poisoning 󠄀Fire 󠄀Maritime 󠄀Bombing 󠄀 Ambush Accident
󠄀LPA/ALPA 󠄀Volcanic Erupti 󠄀 Disease Outbreak, 󠄀Chemical Spills Accident 󠄀Armed Conflict 󠄀 Terrorist Activities
R Tropical Depression 󠄀Lahar specify disease: 󠄀Toxic Waste 󠄀Air Accident 󠄀War 󠄀 Hostage Taking
󠄀Typhoon 󠄀Tsunami _______________ 󠄀Nuclear 󠄀Land 󠄀Mass gathering 󠄀 Coup d'etat
󠄀Storm Surge 󠄀Landslide 󠄀Damaged Transportation 󠄀 Repatriation
󠄀Flooding 󠄀Others, specify Infrastracture Accident 󠄀 Civil Unrest
󠄀Earthquake _______________ 󠄀Trash slide
󠄀Others, specify
________________ 󠄀Explosion (Unintentional) 󠄀Specify _______________
󠄀Others, specify ____________

Date of Occurrence October 20,2020 Time of Occurrence R AM R PM

Place of Occurrence Barangay/Landmark Municipality/City:San Guillermo Province:Isabela Region:II

Brief Description:

B. LIFELINES IN THE AFFECTED AREAS

Lifelines Status Remarks
Communication Landline 󠄀 Available 󠄀 Not Available
Services Cellphone R Available 󠄀 Not Available
Internet R Available 󠄀 Not Available
Electricity Services R Available 󠄀 Partially Available
󠄀 Total black out
Water Services R Available 󠄀 Not Available
Main Roads/Bridges R Passable 󠄀 Not Passable
Airports 󠄀 Functional _xDB40_󠄀 Not Functional
Seaports 󠄀 Functional _xDB40_󠄀 Not Functional
Source:

C. IMPACT OF THE EVENT IN THE COMMUNITY

Please attach updated List of Casualties in the prescribed format. (Add more rows if necessary)
Number of Affected No. of Casualties Evacuation Center
Population
Families Individuals Deaths
CITY/MUNICIPALITY BARANGAYS Injured/ ILL
Total No. of Total No. of
Total No.
Families Individuals inside
of EC
Pre- Hospital OPD Admitted inside EC EC

San Guillermo 26 Barangay 0 0 0 0 0 0 0 0 0

Total:
Source:

D. IMPACT OF THE EVENT ON HEALTH FACILITIES

(Add more rows if necessary)
No. of Health Facilities

Existing Non-
Province/City Damaged Functional Remarks
(Baseline) Functional
DOH ____ DOH ____ DOH ____ DOH ____
San Guillermo Isabela LGU ___1_ LGU _0___ LGU __1__ LGU 0
Military ____ Military ____ Military ____ Military ____
Private ____ Private ____ Private ____ Private ____
Others ____ Others ____ Others ____ Others ____

E. HEALTH PERSONNEL
(Add more rows if necessary) Command System
Percent of personnel reporting to in place? Percent of personnel reporting to work Command System in
work place? place?
CHO/MHO___________________ HOSPITAL_____________________ 󠄀Yes 󠄀󠄀No
󠄀 less than 50 percent R Yes 󠄀󠄀No 󠄀less than 50 percent
R more than 50 percent 󠄀more than 50 percent
BHS______________________ HOSPITAL______________________ 󠄀Yes 󠄀󠄀No
 󠄀 less than 50 percent 󠄀Yes
󠄀more than 50 percent
BHS_____________________
󠄀 less than 50 percent 󠄀Yes
󠄀more than 50 percent
BHS______________________
󠄀 less than 50 percent 󠄀Yes
󠄀more than 50 percent
BHS______________________
󠄀 less than 50 percent 󠄀Yes
󠄀more than 50 percent
󠄀󠄀No 󠄀less than 50 percent
󠄀more than 50 percent
HOSPITAL______________________ 󠄀Yes 󠄀󠄀No
󠄀󠄀No 󠄀more than 50 percent
󠄀less than 50 percent
BHS______________________ 󠄀Yes 󠄀󠄀No
󠄀󠄀No 󠄀more than 50 percent
󠄀less than 50 percent
BHS______________________ 󠄀Yes 󠄀󠄀No
󠄀󠄀No 󠄀more than 50 percent
󠄀less than 50 percent

F. LOGISTICS
Essential Drugs and Medicines
Office
Status For how many days will it last?
PLGU  Adequate    Not adequate
LGU R Adequate    Not adequate
Hospitals  Adequate    Not adequate

G. ACTIONS TAKEN
M/CLGU
R Established Command Center
 Transport to Hospitals
 Admission to Hospitals
 Outpatient Care
 Provided Drinking water
 Evacuated Affected Population
 Management of the Dead & the
Missing
R Rapid Health Assessment
 No details on actions taken
PLGU REGIONAL OFFICE
 Established  Established Command / Operation
Command/Operation Center Center in the affected areas
 Transport to Hospitals  Deployed Response Teams
 Admission to Hospitals  Rapid Health Assessment
 Outpatient Care  Mobilized Logistics
 Mobilized Logistics  Provided Potable Drinking water
 Deployed Response Teams  No details on actions taken
 Provided Drinking water
 Rapid Health Assessment
 No details on actions taken

H. OTHER ACTIONS TAKEN

PLGU:
MEDICAL:

MHPSS:

NIE:

WASH:

CITY/ MUNICIPAL
MEDICAL:

MHPSS:

NIE:

WASH:

DOH REGIONAL OFFICE

MEDICAL:

MHPSS:

NIE:

WASH:

Prepared and Submitted by:

Date Prepared: October 21,2020 Mobile No.: 9267172217
Printed Name: RUTH ANN N. ELEJORDE Landline:
Designation/Office: PHN Fax No.:
Signature: Email: