Activation Forms
Responding to a Disaster
During a Department Operations Center (DOC) activation, complete the relevant forms and e-mail them to: HSADoc@santacruzcounty.us
Use Adobe Acrobat to fill out the forms. Other programs (including the Microsoft Edge web browser) may not save data or support the 'Email Now' function that is located on each form.
Situation Status Forms
Situation Status Form (PHDOC-01)
Report general facility status to Emergency Preparedness and Response.
Download
Resource Request Form - Supplies and Equipment (PHDOC-02)
Submit a request for additional supplies in the event of an emergency. A PPE Request Application is required to be submitted with all PPE Resource Requests (PH-DOC02).
Download
Resource Request Form - Personnel (PHDOC-03)
Submit a request for additional staffing support with this form. See a list of all available MRC volunteer categories.
Download
Capacity Assistance Forms
Assistance Capacity Report for Clinics (PHDOC-04)
Report facility hours, service expansion capabilities, or your organization’s ability to support additional services, if requested.
Download
Assistance Capacity Report for Surgery Centers (PHDOC-05)
Report facility hours, service expansion capabilities, or your organization’s ability to support additional services, if requested.
Download
Assistance Capacity Report for Skilled Nursing Facilities (SNFs) and Long-term Care Facilities (LTCFs) (PHDOC-06)
Report facility hours, service expansion capabilities, or your organization’s ability to support additional services, if requested.
Download
Patient Tracking Forms
HICS 255 Master Patient Evacuation Tracking Form
Download
HICS 260 Patient Evacuation Tracking Form
Download
Instructions & Exercise Forms
Instructions for use of PH DOC 01, 02, and 03:
Instructions
ICS 214 Unit Log
Document all of your facility’s response activities in the event of a disaster.
Download