Basic Incident Command System Course

Assignment 4: Incident Action Plan

Please fill-up the details below:

Name
Agency/Organization
OCD ID Number

Instruction(s):

1. This assignment shall be accomplished per group which shall be assigned by the facilitator.

2. Refer to the same Rizal Earthquake scenario (Assignment 1), the scenario update and the
accomplished ICS Forms 215 and 215A (Assignment 3).

3. Based on the information provided, come up with the Incident Action Plan (IAP) by
accomplishing the forms below. Use the Operational Period: 17 September 20xx, 0600H –
1800H.

 ICS Form 202 (page 3)

 ICS Form 203 (page 4)
 ICS Form 204 (page 5; more forms may be added as necessary)
 ICS Form 205 (page 8)
 ICS Form 206 (page 9)
 ICS Form 208 (page 10)

4. Once accomplished, save the file using the filename template <Group
Number>_<Assignment Number> (example: Group 1_Assignment 4).

Deadline is not later than 1600H of this day.

Incident Action Plan
Rizal Earthquake

17 September 20xx
0600H – 1800H

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 INCIDENT OBJECTIVES
ICS 202

1. INCIDENT/EVENT NAME 2. OPERATIONAL PERIOD

From (Date and Time):
To (Date and Time):
3. OBJECTIVES FOR THE OPERATIONAL PERIOD

4. OPERATIONAL PERIOD COMMAND EMPHASIS

5. GENERAL SITUATION AWARENESS (WEATHER FORECAST)

6. GENERAL SAFETY MESSAGE

7. SITE SAFETY PLAN REQUIRED? ___ YES ____ NO

Location of Approved Site Safety Plan:

8. ATTACHMENTS (CHECK IF ATTACHED)

ORGANIZATION MEDICAL PLAN - OTHERS:
LIST - ICS 203 ICS 206

DIV. ASSIGNMENT SAFETY MESSAGE/

LISTS - ICS 204 PLAN - ICS 2018

COMMUNICATIONS INCIDENT/EVENT
PLAN - ICS 205 MAP

9. Prepared by PSC Name and Signature: Date Prepared: Time Prepared:

10. Approved by IC Name and Signature: Date Approved: Time Approved:

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 ORGANIZATION ASSIGNMENT LIST
ICS 203
1. INCIDENT/EVENT NAME 2. OPERATIONAL PERIOD
From (Date and Time):
To (Date and Time):
3. INCIDENT COMMANDER AND COMMAND STAFF 7. OPERATIONS SECTION
Incident Commander Chief
Deputy Deputy
Safety Officer A. BRANCH I
Information Officer Branch Director
Liaison Officer Deputy
4. AGENCY REPRESENTATIVES Division/Group

Agency Names Division/Group

Division/Group
Division/Group
B. BRANCH II
Branch Director
Deputy
Division/Group
5. PLANNING SECTION Division/Group
Chief Division/Group
Deputy Division/Group
Resource Unit C. BRANCH III
Situation Unit Branch Director
Documentation Unit Deputy
Demobilization Unit Division/Group
Technical Specialists Division/Group
Division/Group
Division/Group
D. AIR OPERATIONS BRANCH

6. LOGISTICS SECTION
Chief
Deputy E. WATER OPERATIONS BRANCH
SUPPORT BRANCH
Director
Supply Unit
Facilities Unit 8. FINANCE/ADMINISTRATIVE SECTION
Ground Support Unit Chief
SERVICE BRANCH Deputy
Director Time Unit
Communications Unit Procurement Unit
Medical Unit Compensation/Claims Unit
Food Unit Cost Unit
9. Prepared by RESL Name and Signature: Date Prepared: Time Prepared:

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 ASSIGNMENT LIST
ICS 204
1. INCIDENT/ EVENT NAME 2. OPERATIONAL PERIOD 3. Branch:
From (Date and Time): Group:
To (Date and Time): Division:
Staging Area:
4. OPERATIONS PERSONNEL
Position Name Contact Number(s)
Operations Section Chief
Branch Director
Staging Area Manager
Division /Group Supervisor
Air/Water Tactical Group Supervisor
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

6. SPECIFIC WORK ASSIGNMENT

7. SPECIAL INSTRUCTIONS/ SAFETY MEASURES

8. COMMUNICATIONS SUMMARY
Function System Channel Frequency Others (mobile, satellite phone, etc.)

9. Prepared by RESL Name and Signature: Date Prepared: Time Prepared:

More ICS 204 forms may be added as necessary

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 ASSIGNMENT LIST
ICS 204
1. INCIDENT/ EVENT NAME 2. OPERATIONAL PERIOD 3. Branch:
From (Date and Time): Group:
To (Date and Time): Division:
Staging Area:
4. OPERATIONS PERSONNEL
Position Name Contact Number(s)
Operations Section Chief
Branch Director
Staging Area Manager
Division /Group Supervisor
Air/Water Tactical Group Supervisor
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

6. SPECIFIC WORK ASSIGNMENT

7. SPECIAL INSTRUCTIONS/ SAFETY MEASURES

8. COMMUNICATIONS SUMMARY
Function System Channel Frequency Others (mobile, satellite phone, etc.)

9. Prepared by RESL Name and Signature: Date Prepared: Time Prepared:

More ICS 204 forms may be added as necessary

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 ASSIGNMENT LIST
ICS 204
1. INCIDENT/ EVENT NAME 2. OPERATIONAL PERIOD 3. Branch:
From (Date and Time): Group:
To (Date and Time): Division:
Staging Area:
4. OPERATIONS PERSONNEL
Position Name Contact Number(s)
Operations Section Chief
Branch Director
Staging Area Manager
Division /Group Supervisor
Air/Water Tactical Group Supervisor
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

6. SPECIFIC WORK ASSIGNMENT

7. SPECIAL INSTRUCTIONS/ SAFETY MEASURES

8. COMMUNICATIONS SUMMARY
Function System Channel Frequency Others (mobile, satellite phone, etc.)

9. Prepared by RESL Name and Signature: Date Prepared: Time Prepared:

More ICS 204 forms may be added as necessary

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 COMMUNICATIONS PLAN
ICS 205

1. INCIDENT/EVENT NAME 2. OPERATIONAL PERIOD

From (Date and Time):
To (Date and Time):
3. BASIC RADIO CHANNEL UTILIZATION
Radio Others (mobile phone,
System Channel Function Tone/ Offset Frequency Assignment Remarks
Type satellite phone, etc.)

4. COORDINATING INSTRUCTIONS

5. Prepared by COML Name and Signature: Date Prepared: Time Prepared:

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 MEDICAL PLAN
ICS 206

1. INCIDENT/EVENT NAME 2. OPERATIONAL PERIOD

From (Date and Time):
To (Date and Time):
3. MEDICAL AID STATIONS
Contact With Paramedics? Remarks
Name Location Contact Person
Number(s) Yes No

4. AMBULANCE/ MEDICAL TRANSPORTATION SERVICES

Contact Level of Service Remarks
Name Location Contact Person
Number(s) BLS ALS

5. HOSPITALS
With With With
Contact Contact Travel Time Trauma Burn Helipad?
Name Location Center? Center?
Person Number(s)
Air Land Yes No Yes No Yes No

6. MEDICAL EMERGENCY PROCEDURES

__ Check if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations Branch.

7. Prepared by MEDL Name and Signature: Date Prepared: Time Prepared:

8. Reviewed by SOFR Name and Signature: Date Reviewed: Time Reviewed:

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 SAFETY MESSAGE/ PLAN
ICS 208

1. INCIDENT/ EVENT NAME 2. OPERATIONAL PERIOD

From (Date and Time):
To (Date and Time):
3. SAFETY MESSAGE

4. SITE SAFETY PLAN REQUIRED? YES  NO

LOCATION OF SAFETY PLAN: ____________________________

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5. Prepared by SOFR Name and Signature: Date Prepared: Time Prepared:

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