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Subj: //WL2K / Msg # INITIAL IMPACT ASSESSMENT
Msg:
Precedence:
Message Number:
Station of Origin:
Place of Origin: , BC
Time (local):
Date (local):
To Name: PREOC Operations
Organization: EMBC
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INITIAL IMPACT ASSESSMENT REPORT
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1A) Is EOC activated?
1B) EOC Activation Status?
1C) State of Local Emergency Declared?
1D) EOC Comments:
1E) First Responders Functional?
2A) Number of people displaced:
2B) Number of people injured:
2C) Number of fatalities:
2D) Have people been evacuated?
2E) Number of people evacuated:
Critical Infrastructure Impacted
______________________________________________
3A) Water: - - (ETR)
3B) Sanitation: - - (ETR)
3C) Gas: - - (ETR)
3D) Electricity: - - (ETR)
3E) Telephone: - - (ETR)
3F) Internet: - - (ETR)
3G) Cellular Network: - - (ETR)
3H) Text Messaging: - - (ETR)
3I) SAT Phone: - - (ETR)
3J) Amateur Radio Station Status: (ETR)
Callsign:
Winlink address:
______________________________________________
4A) If potable water system is unusable, estimated days remaining of water:
4B) Estimated days remaining of food:
5) Primary Transportation Route:
6) Medical - Hospitals/Clinics:
7A) Shelter - estimated % of homes uninhabitable:
7B) Estimated percentage of Rapid Damage Assessment completed:
8) Priority Needs (3 only)
1)
2)
3)
9) Comments:
_____________________________________________________________________
Report Originator:
Organization:
Radio Station Callsign:
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