April 29, 2018

ASSIGNMENT LIST
ICS 204
1. INCIDENT/ EVENT NAME 2. OPERATIONAL PERIOD 3. TF SAR
From (Date and Time): SEPTEMBER 16, 20XX,
RIZAL EARTHQUAKE 0600H
To (Date and Time): SEPTEMBER 16, 20XX,
1800H
4. OPERATIONS PERSONNEL
Position  Name Contact Number(s)
Operations Section Chief Dax C. Agpasan 09172425378
Branch Director
Staging Area Manager
Division /Group Supervisor
TF Leader Dwayne A. Johnson 09775871299
5. RESOURCES ASSIGNED FOR THIS PERIOD
Name of Trans. Drop off point and Pick-up time Remarks
Contact No. of Needed?
Resource Identifier Leader time at area of from area of
Numbers Personnel
Yes No assignment assignment
SAR-1 Mar T. Roxas 09171235861 10 /
SAR-2 Edu G. Marzan 09751254867 10 /
PT-1 Joe S. Lim 09775486158 4 /
Ping W.
09158478457 4 /
PT- 2 Lacson
AMB-1 Paul O. Simon 09457891171 3 /

6. SPECIFIC WORK ASSIGNMENT

SAR-1 and SAR-2– Conduct search and rescue operation at Ridge School
AMB-1 – Transport all injured victims from Ridge school to Medical Station/Rizal General Hospital
PT-1 and PT-2 – Conduct security and traffic procedure at Ridge School area

7. SPECIAL INSTRUCTIONS/ SAFETY MEASURES

- Don’t get separated

- Perform buddy system at all times
- Wear PPEs and high visibility vest
-  Stay hydrated

8. COMMUNICATIONS SUMMARY
Function System Channel Frequency Others (mobile, satellite phone, etc.)
Rizal 1 188.100 Mhz.
Command 09176548927
Tactical 1 Rizal 2 188.200 Mhz 097745816478

Name and Signature: Date Prepared: Time Prepared:

9. Prepared by RESL
10. Approved by IC
Francisco C. Tuazon, III September 15, 20XX 1230H
Name and Signature: Time Prepared:
Date Prepared:
Kristian Mark Moises L. 1300H
September 15, 20XX
Bugnosen
 April 29, 2018
ICS 204: ASSIGNMENT LIST

PURPOSE: The ICS 204 informs the Division and Group supervisors of incident assignments. Once the
Command and General Staff agree to the assignments, the assignment information is given to the
appropriate Divisions and groups.

PREPARATION: For major incidents, the ICS 204 is normally prepared by the Resource Unit Leader
(RESL) using the guidance of ICS 202, 215 and based on the directives of the Operations Section
Chief (OSC). It may also be initiated by the Planning Section Chief (PSC) and the OSC.

DISTRIBUTION: The ICS 204 is duplicated and attached to the ICS 202 and given to all recipients as
part of the Incident Action Plan (IAP). All completed original forms must be given to the Documentation
Unit.

HOW TO FILL-UP THE FORM:

BLOCK NO. BLOCK TITLE INSTRUCTIONS

1 Incident/Event Name Enter the name assigned to the incident/event
2 Operational Period Enter the start date (month-dd-yyyy) and time (24 hour
format) and end date and time for the operational period to
which the form applies.
3 Branch This block is for use in a large IAP for reference only. Enter
Group the appropriate alphanumeric abbreviation as appropriate.
Division Eg. Branch 1, Division A, etc.
Staging Area
4 Operations Personnel Enter the names, agencies/offices, and contact numbers of
the OSC and the applicable Branch Director (s) and
Division/Group Supervisor (s).

Note that there may be two or more divisions or groups

during an operational period. Use additional 204s as
needed.
5 Resources assigned Enter information about resources assigned for this
for this Period operational period
Resource Identifier Enter the breakdown of resources assigned for the
Branch/Division/Group/Staging Area.

Indicate the resource identifier and specify if you are going

to use single resource, strike team or task force for each.

If strike team or task force, enter in the succeeding blocks

the breakdown of resources composing the said strike team
or task force.

Notes:
 The breakdown of resources for this block shall be
obtained from the Operational Planning Worksheet
(ICS 215).
 Remember to maintain the maximum span of
control.
Name of Leader Enter the name of the leader assigned for the unit or
resource.

Note: The name of leader for every single resource, strike

team or task force indicated in this form shall be entered.
 April 29, 2018
Contact Details Enter the contact details of the leader.

Note: The contact details of leader for every single

resource, strike team or task force indicated in this form
shall be entered.
No. of Personnel Enter the number of personnel for the unit or resource.
Trans. Needed? Check “Y” for yes or “N” for no if the resources requires to
be transported
Drop off point and time If “Y” is checked, enter specific location and time where the
at area of assignment resources should be dropped off after the briefing.

If “N” is checked, no need to fill-up this section.

Pick-up time from area If “Y” is checked, enter specific location and time where the
of assignment resources should be picked-up after the conduct of
operations.

If “N” is checked, no need to fill-up this section.

Remarks Enter other important details about the resource such as
special equipment and supplies; whether or not the
resource received briefings; specific transportation needs;
or other information.
6 Specific Work Enter statement of tactical objectives to be achieved within
Assignment the operational period by the personnel assigned to this
Division or Group. Also indicate the specific locations where
they will perform their assignment.

Note: The information for this block can be referred from

the Operational Planning Worksheet (ICS 215)
7 Special Instructions/ Enter a statement noting any safety precautions to be
Safety Measures exercised or other important information.

Note: The information for this block can be referred from

the Operational Planning Worksheet (ICS 215)
8 Communications Enter specific communications information (including
Summary emergency numbers) for this Branch/Division/Group. If
radios are being used, enter function (command, tactical,
support, etc.,) frequency, system, and channel from the
Incident Radio Communications Plan (ICS 205). In light of
potential IAP distribution, use sensitivity when including
cellphone numbers. Add a secondary contact (phone
number or radio)if needed
9 Prepared by RESL Enter complete name of the RESL, signature, date (month-
dd-yyyy), and time (24 hour format) the form was prepared
and completed.

The form is prepared usually by the RESL. In the absence

of RESL, it shall be prepared by the PSC or OSC.