Form 1 Rev.

4/7/2007
Republic of the Philippines
Department of Health
HEALTH EMERGENCY MANAGEMENT STAFF
Ground Floor, Bldg. 12, San Lazaro Compound
Rizal Avenue, Sta. Cruz, Manila
Telefax: (63-2)711-1001/ 740-5030/ 743-0568 Tel: (63-2)711-1002/ 743-0538
Trunk line Nos. 743-8301 loc 2200 to 2207
Email: doh_hems@yahoo.com; doh_hemsopcen@yahoo.com

MAJOR EVENT MONITORING SHEET

Event Title: ________________________________________________________
(This template shall be initiated by the EOD for every major health emergency or disaster recorded in Template A, Section C.
It shall be updated by all EODs and remain active until the case is closed and the Final Report (Template F) is prepared)

A. Initial Report About the Event and Its Health Consequences

Date of Initial Report: EOD:
Type of Event: GEOLOGIC WEATHER BIOLOGIC MAN-MADE
❑Volcanic Eruption ❑Typhoon ❑Red Tide ❑Epidemic ❑Poisoning, specify ________________
❑Earthquake ❑Storm Surge ❑Fish Kills ❑Fire ❑Mass Action, specify ______________
❑Tsunami ❑Drought ❑Locust ❑Explosion ❑Accident, specify _________________
❑Landslide ❑Cold Spell ❑Infestation ❑Armed Conflict ❑Other, specify____________________
❑Lahar ❑Flashflood ❑Terrorism
Date of Time of ❑AM Exact Location:
Ocurrence: Occurrence: ❑PM Region: Province: Municipality/City:
Brief Description:

HEALTH IMPACT POPULATION DISPLACEMENT HEALTH FACILITIES / SERVICES

No. of Deaths: Population displaced? ❑Yes ❑No Number Number
No. of Admitted Patients: No. of Displ. Families: ❑Actual Present Functional
No. of Outpatients: ❑Estimated Public
No. Missing: No. of Disp. Individuals: ❑Actual Hospitals:
❑Estimated RHUs:
B. Updates on the Health Consequences (This section shall be used to update health consequences as reports are received from the field)
As of Displaced Displaced
Deaths Admitted Outpatients Missing Other Information Source EOD
Date Families Individuals

C. Reports Received
REGULAR REPORTS Date Rcvd EOD OTHER REPORTS RECEIVED Date Rcvd EOD
HEARS Field Report 1.
Rapid Health Assessment 2.
Health Situation Update No. 1 3.
Health Situation Update No. 2 4.
Health Situation Update No. 3 5.
HEMS Coordinator’s Final Report 8.
D. Reports Prepared
REPORTS PREPARED Date Prepared Submitted To EOD
Flash Report Time Prepared: __________
Briefer
Final Report
OTHER REPORTS PREPARED Date Prepared Submitted To EOD
1.
2.
3.
E. Issues and Problems
Issues and Problems Encountered Date EOD
1.
2.
3.
4.