Prepare
General
PDF
CAHF: Disaster Preparedness Inventory List
This list can be utilized by a facility to maintain a list of systems, equipment and supplies.
Updated 4/10/2018
PDF
CAHF: Facility Profile Sheet
This facility profile is a document that provides a general overview and listing of relevant information pertaining to operational and property characteristics.
Updated 4/10/2018
PDF
CAHF: Facility Staff Emergency Contact List
Facilities can use this tool to identify and retain contact information of staff.
Updated 4/10/2018
PDF
CAHF: Guide for Mass Fatality Planning
This document will assist facilities in planning for potential of handling of deceased residents, staff, and visitors following a major event.
Updated 4/10/2018
PDF
CAHF: Hazard Vulnerability Chart/Worksheet
This checklist can be used to assist in conducting annual review of a facility’s Hazard Vulnerability Analysis (HVA).
Updated 4/10/2018
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Emergency Operations Plan Manual Review, Revision and Distribution Log
A facility's Emergency Operations Plan/Manual should be reviewed annually and updated as needed. This checklist provides a log of those reviews and plan distribution.
Updated 4/10/2018
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Emergency Preparedness Program Evaluation Worksheet
The following checklist can be used to evaluate a facility's emergency/disaster plans and identify opportunities for improvement and enhancement.
Updated 4/10/2018
WWW
Kaiser Permanente: Hazard Vulnerability Assessment Tool (2017)
This HVA tool was created by Kaiser Permanente and is known as the "gold standard" for health care hazard planning. This document will be the most common version at healthcare coalition and/or county meetings.
Updated 4/10/2018
Active Shooter/Workplace Violence
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Keep It With You: Personal Medical Information Form
The “Keep It With You” Personal Medical Information Form is intended to be a voluntary and temporary record that lists medical care and other health information for people who need care during disasters and similar situations.
Updated 4/10/2018
Earthquakes
WWW
CDC: Guidance for Earthquake Preparedness (weblink)
To maintain facility operations for a minimum of 96-hours following a major earthquake that may impact the structural integrity of the facility, and to insure the continum of care for patients, visitors, and casualties of the event. Surviving an earthquake and reducing its health impact requires preparation, planning, and practice. In this webpage by CDC, learn about actions you can take to help you and your remain safe and healthy in the event of an earthquake.
Updated 4/10/2018
Evacuation
DOC
CAHF: Resident Assessment Form for Transport & Destination
This form is used to periodically review and assess the facility population for evacuation transport and relocation, transport and relocation needs.
Updated 4/10/2018
PDF
Evacuation Client "GO KIT"
Use form as a checklist for suggested contents that a facility might need during an evacuation.
Updated 4/10/2018
PDF
Keep It With You: Personal Medical Information Form
The “Keep It With You” Personal Medical Information Form is intended to be a voluntary and temporary record that lists medical care and other health information for people who need care during disasters and similar situations.
Updated 4/10/2018
PDF
NHICS Activation Guidance
NHICS is a framework for response that can be easily integrated into a long-term care facility's existing emergency operation plan (EOP). Regular utilization of NHICS on non‐emergency situations that require a coordinated response can help develop a consistent and disciplined approach to incident management. This guidance will promote this practice.
Updated 4/10/2018
PDF
Safe Evacuation Tabletop Exercise Guide for LTC Facilities
This guidebook will help Long Term Care facilities evaluate their
preparedness for an evacuation. This guidebook contains all the materials
necessary to conduct a simulated evacuation using a type of drill called a tabletop exercise.
preparedness for an evacuation. This guidebook contains all the materials
necessary to conduct a simulated evacuation using a type of drill called a tabletop exercise.
Updated 4/10/2018
Fire (Internal, External, Wildfires)
PDF
NHICS Incident Response Guide - Fire (Internal & External) (2017)
To safely mange the operation of the facility during response to an internal fire incident.
Updated 4/10/2018
General Information & Links
WWW
CAHF: Updated Emergency Operations Plan Template (2017)
This template is a tool that should be customized to fit the circumstances and needs of your facility.
Updated 4/10/2018
WWW
CDC: Guidance for Earthquake Preparedness (weblink)
To maintain facility operations for a minimum of 96-hours following a major earthquake that may impact the structural integrity of the facility, and to insure the continum of care for patients, visitors, and casualties of the event. Surviving an earthquake and reducing its health impact requires preparation, planning, and practice. In this webpage by CDC, learn about actions you can take to help you and your remain safe and healthy in the event of an earthquake.
Updated 4/10/2018
PDF
First Things First: Long-Term Care Survival Self-Assessment Checklist
The “First Things First” checklist is a quick assessment tool intended to help long‐term care providers identify
key actions they can take to become minimally prepared to survive a widespread disaster. However it is NOT a substitute for a comprehensive emergency operations plan.
key actions they can take to become minimally prepared to survive a widespread disaster. However it is NOT a substitute for a comprehensive emergency operations plan.
Updated 4/10/2018
PDF
Keep It With You: Personal Medical Information Form
The “Keep It With You” Personal Medical Information Form is intended to be a voluntary and temporary record that lists medical care and other health information for people who need care during disasters and similar situations.
Updated 4/10/2018
Shelter-In-Place/Lockdown
PDF
NHICS Activation Guidance
NHICS is a framework for response that can be easily integrated into a long-term care facility's existing emergency operation plan (EOP). Regular utilization of NHICS on non‐emergency situations that require a coordinated response can help develop a consistent and disciplined approach to incident management. This guidance will promote this practice.
Updated 4/10/2018