Hospital Preparedness Program Partnership (HPP)

DOC Forms

During a DOC activation, fill in the documents below and e-mail to: hsadoc@co.santa-cruz.ca.us

• Instructions for use of PH DOC 01, 02, & 03
• Situation Status Form (PHDOC01)
• Resource Request Form -- Supplies and Equipment (PH DOC 02)
• Resource Request Form -- Personnel (PH DOC 03)
• What kinds of staff can the MRC provide?
• Assistance Capacity Report for Clinics (PH DOC 04)
•  Assistance Capacity Report for Skilled Nursing Facilities/Surgery Centers (PH DOC 05)
  • This form is in Microsoft Word format. Once it opens, remember to choose File > Save As and save the document to your PC.
• Patient Evacuation Tracking Form
• HICS 255 Master Patient Evacuation Tracking Form
• HICS 260 Patient Evacuation Tracking Form
• ICS 214 Unit Log
• Participant Critique Sheet

Web Links

• Hazard Vulnerability Analysis (HVA) - The HVA provides a systematic approach to recognizing hazards that may affect demand for the hospitals services or its ability to provide those services.
• HHS.gov - Description of HPP Program

Continuity of Operations Templates

• Behavioral Health
  • This form is in Microsoft Word format. Once it opens, remember to choose File > Save As and save the document to your PC.
• Public Laboratory
  • This form is in Microsoft Word format. Once it opens, remember to choose File > Save As and save the document to your PC.
• Long Term Care Facility/ Skilled Nursing Facility
  • This form is in Microsoft Word format. Once it opens, remember to choose File > Save As and save the document to your PC.
• Clinic
  • This form is in Microsoft Word format. Once it opens, remember to choose File > Save As and save the document to your PC.
• Public Health
  • This form is in Microsoft Word format. Once it opens, remember to choose File > Save As and save the document to your PC.
• Pharmacy
  • This form is in Microsoft Word format. Once it opens, remember to choose File > Save As and save the document to your PC.