Advanced Practice CentersSan Francisco Bay Area Advanced Practice Centers - Tools for Infectious Disease Emergencies
 

Appendices

The Appendices contain a variety of sample and modifiable templates to help execute the Infectious Disease Emergency Response Plan, including Job Action Sheets, Health Alerts, public health-specific Incident Command System forms, and protocols. Local health departments may modify the templates for use in their own jurisdictions.

 

Table of Contents for Appendices

Table of Contents for Job Action Sheets


ICS Forms
ResourceDownload
Incident Action Plan Cover Sheet IAP
Incident Briefing Form #201
Incident Objectives and Update Form #202
Module Objectives and Update Form #202b
Personnel and Communication List #205
Medical Plan Form #206
Personnel Sign-In Form #211
General Message Form #213
Resource Order Form #308
ICS Forms Overview
ICS Forms Workbook (Contributed by the Southern Nevada Health District) note: enable macros to navigate
Activation and Notification
ResourceDownload
IDER Activation & Notification Protocol
IDER Pre-Assigned Staff Template
Job Action Sheets
Instructions For All Responders
ResourceDownload
Instructions for all Responders
Command
ResourceDownload
Incident Commander
Deputy Incident Commander
Administrative Assistant
Information Officer
Safety Officer
Liason Officer
Media Officer
Continuity of Operations Officer
Field Officer
DOC Manager
Policy Group Member
Plans Section
ResourceDownload
Plans Section Chief
Plans Section Deputy
Administrative Assistant
Situational Status Unit
ResourceDownload
Situation Status Unit Leader
Situation Status Unit Member
Situation Status Unit Displayer
Resource Status Unit
ResourceDownload
Resource Status Unit Leader
Resource Status Unit Member
Documentation Unit
ResourceDownload
Documentation Unit Leader
Documentation Unit Member
Technical Specialist Unit
ResourceDownload
Technical Specialist Unit Leader
Technical Specialist Unit Member
Demobilization Unit
ResourceDownload
Demobilization Unit Leader
Demobilization Unit Member
Operations Section
ResourceDownload
Operations Section Chief
Operations Section Deputy
Administrative Assistant
Information & Guidance Branch
ResourceDownload
Information and Guidance Branch Director
Information and Guidance Branch Deputy
Administrative Assistant
Inquiries Group
ResourceDownload
Inquiries Group Supervisor
Inquiries Group Member
Phone Bank Team Leader
Phone Bank Team Member
Content Group
ResourceDownload
Content Group Supervisor
Content Group Member
ICOH Guidance Team Leader
ICOH Guidance Team Member
Clinician Guidance Team Leader
Clinician Guidance Team Member
Clinician Consultation Unit Leader
Clinician Consultation Unit Member
Public Guidance Team Leader
Public Guidance Team Member
Special Setting Guidance Team Leader
Special Setting Guidance Team Member
Dissemination Group
ResourceDownload
Dissemination Group Supervisor
Dissemination Group Member
Disease Containment Implementation Branch
ResourceDownload
Disease Containment Implementation Branch Director
Disease Containment Implementation Branch Deputy
Administrative Assistant
Community Mitigation Group
ResourceDownload
Community Mitigation Group Supervisor
Community Mitigation Group Member
Mass Prophylaxis Group
ResourceDownload
Mass Prophylaxis Group Supervisor
POD Area Manager
POD Manager
POD Assistant Manager
POD Safety Officer
POD Operations Chief
POD In/Out Flow Lead
POD Entry Staff Person
POD Exit Staff Person
POD Line Monitor
POD Medical Lead
POD Screening Lead
POD Triage Staff Person
POD Prophylaxis Screener
POD Medical Consultant
POD Dispensing Lead
POD Dispenser
POD Re-stocker
POD Pharmacy/ Drug Preparation Lead
POD Drug Preparation Staff Person
POD Mental Health Lead
POD Mental Health Provider
POD Data Collection Lead
POD Forms Distribution Lead
POD Forms Distributor
POD Forms Collection Lead
POD Forms Collector
POD Data Collector
POD Public Information/ Education Lead
POD Educator
POD Operations Runner
POD Logistics Chief
POD Supplies Lead
POD Receiving/ Uploading Staff Person
POD Supplies Inventory Staff Person
POD Personnel Lead
POD Communications Lead
POD Communications Monitor
POD Facilities Lead
POD Maintenance Staff Person
POD Waste Disposal Liaison
POD Food and Drink Staff Person
POD Logistics Runners
POD Float Staff Person
POD Security
POD EMT
Push Distribution Manager
Push Distribution Staff
POD SAT Manager
POD SAT Assistant Safety Officer
POD SAT Assistant Operations Chief
POD SAT Check-In/ Registration Lead
POD SAT Check-In/ Registration Staff Person
POD SAT Assignment Lead
POD SAT Assignment Staff Person
POD SAT Training Lead
POD SAT Response Trainer
POD SAT Station Trainer
POD SAT Deployment Coordinator
POD SAT Runner
POD SAT Assistant Logistics Chief
POD SAT Supplies Lead
POD SAT Supplies Staff Person
POD SAT Personnel Lead
POD SAT Communications Lead
POD SAT Communications Staff Person
POD SAT Facilities Lead
POD SAT Facilities Staff Person
Restriction, Exclusion, and Clearance Group
ResourceDownload
Restriction, Exclusion, & Clearance Group Supervisor
Restriction, Exclusion, & Clearance Group Member
Isolation and Quarantine Group
ResourceDownload
Isolation and Quarantine Group Supervisor
Isolation and Quarantine Group Member
Home Isolation and Quarantine Team Leader
Home Isolation and Quarantine Team Member
Isolation and Quarantine Field Team Leader
Isolation and Quarantine Field Team Clinician
Isolation and Quarantine Field Team Member
Driver
Facility Isolation and Quarantine Team Leader
Facility Isolation and Quarantine Team Clinician
Facility Isolation and Quarantine Team Clinical Member
Facility Management Team Leader
Facility Management Team Member
Medical Branch
ResourceDownload
Medical Branch Director
Administrative Staff
EMS/ Medical Transport Group
ResourceDownload
EMS/ Medical Transport Group Supervisor
EMS/ Medical Transport Group Member
Healthcare Facilities Group
ResourceDownload
Healthcare Facilities Group Supervisor
Hospital Team Leader
Hospital Team Member
Community Clinic Team Leader
Community Clinic Team Member
Mental Health Clinic Team Leader
Mental Health Clinic Team Member
Alternative Care/ Shelters Sites Team Leader
Alternative Care/ Shelter Sites Team Member
Mass Fatalities Group
ResourceDownload
Mass Fatalities Group Supervisor
Mass Fatalities Group Member
Epidemiology & Surveillance Branch
ResourceDownload
Epidemiology and Surveillance Branch Director
Epidemiology and Surveillance Branch Deputy
Administrative Assistant
Investigation Group
ResourceDownload
Investigation Group Supervisor
Investigational Epidemiologist
Case Investigation Team Leader
Case Investigator
Contact Investigation Team Leader
Contact Investigator
Coordinating Field Investigation Team Leader
Field Investigation Team Leader
Field Investigator
Laboratory Liaison Team Member
Laboratory Liaison Team Leader
Surveillance Group
ResourceDownload
Surveillance Group Supervisor
Surveillance Epidemiologist
Surveillance Team Member
Surveillance Team Leader
Syndromic Surveillance Team Leader
Syndromic Surveillance Team Member
Syndromic Surveillance Field Unit Leader
Syndromic Surveillance Field Unit Epidemiologist
Laboratory Group
ResourceDownload
Laboratory Group Supervisor
Lab Testing Team Leader
Lab Testing Microbiologist_Sample Prep Unit
Lab Testing/Data Entry Assistant_Sample Prep Unit
Lab Testing Microbiologist_PCR Unit
Lab Testing Microbiologist_Conventional Testing Unit
Lab Receiving/Documentation Team Leader
Lab Testing/Data Entry Assistant_Lab Receiving/Documentation Team
Lab Surge Team Leader
Lab Testing/Data Entry Assistant_Lab Surge Team
Data Branch
ResourceDownload
Data Branch Director
Administrative Assistant
Data Analysis Group
ResourceDownload
Data Analysis Group Leader
Data Epidemiologist
Data Analyst
Data Entry Staff
Data Analysis Administrative Assistant
Data Software Support Group
ResourceDownload
Data Software Support Group Supervisor
Database Staff
Logistics Section
ResourceDownload
Logistics Section Chief
Logistics Section Deputy
Administrative Assistant
Personnel Unit
ResourceDownload
Personnel Unit Leader
Personnel Unit Staff
Volunteer Management Team Leader
Volunteer Management Team Member
Staff Staging Area Team Leader
Staff Staging Area Team Member
PPE Training Staff
Supplies Unit
ResourceDownload
Supplies Unit Leader
Supplies Unit Staff
Supplies Unit Runner
Pharmaceutical and Medical Supplies Team Leader
Local Pharmaceutical Cache Leader
HLS Cahce Manager
Facility Cache Manager
External Pharmaceutical and Medical Supplies Leader
RSS Warehouse Site Manager (Incident Commander)
RSS Security Officer
RSS Pharmacy Liaison
RSS Logistics Section Chief
RSS Operations Section Chief
RSS Inventory Control Specialist
RSS Inventory Control Supply Officer
RSS Data Entry Coordinator
RSS Communications Specialist
RSS Transportation Coordinator
RSS Vehicle Dispatch
RSS Warehouse Team Leader
RSS Workforce Group
Facilities Unit
ResourceDownload
Facilities Unit Leader
Facilities Unit Staff
Communication Equipment Unit
ResourceDownload
Communication Equipment Unit Leader
Communication Equipment Unit Staff
Information Technology Unit
ResourceDownload
Information Technology Unit Leader
Information Technology Unit Staff
Finance Section
ResourceDownload
Finance Section Chief
Finance Section Deputy
Administrative Assistant
Procurement Unit
ResourceDownload
Procurement Unit Leader
Procurement Unit Staff
Cost Unit
ResourceDownload
Cost Unit Leader
Cost Unit Staff
Time Tracking Unit
ResourceDownload
Time Tracking Unit Leader
Time Tracking Unit Staff
Claims Unit
ResourceDownload
Claims Unit Leader
Claims Unit Staff
Plans
ResourceDownload
Guidance for the Scale and Scope of a Pandemic Flu Response
Demobilization Plan
After Action Report
Command Staff Meeting Agenda
Demobilization Debrief Agenda
ICS Forms Tracking Spreadsheet
Information and Guidance
Health Alerts
ResourceDownload
Health Alert Template
Anthrax Pre-written Health Alert
Botulism Pre-written Health Alert
Brucellosis Pre-written Health Alert
Burkholderia (Glanders/Melioidosis) Pre-written Health Alert
Plague Pre-written Health Alert
Smallpox Pre-written Health Alert
Tularemia Pre-written Health Alert
Viral Hemorrhagic Fever (VHF) Pre-written Health Alert
Health Alert content for Biohazard Detection System (BDS)
Fact Sheets (FAQs)
ResourceDownload
Anthrax FAQs
Botulism FAQs
Brucellosis FAQs
Burkholderia (Glanders/Melioidosis) FAQs
Plague FAQs
Smallpox FAQs
Tularemia FAQs
Viral Hemorrhagic Fevers FAQs
Avian Influenza One Page FAQs
Measles FAQs
Clinician Reference Documents
ResourceDownload
Anthrax, Infectious Disease Emergency Guide
Avian Influenza, Infectious Disease Emergency Guide
Botulism, Infectious Disease Emergency Guide
Brucellosis, Infectious Disease Guide
Plague, Infectious Disease Emergency Guide
Smallpox, Infectious Disease Emergency Guide
Tularemia, Infectious Disease Emergency Guide
Viral Hemorrhagic Fevers, Infectious Disease Emergency Guide
Bioterroism Syndromes Poster
Information and Guidance Protocols
ResourceDownload
Log of Requests, Assignments, and Disseminations
Calendar of Conference Calls
Health Alert Request Form
Protocol for Health Alert Dissemination
Final Materials Tracking Spreadsheet
Infection Control Materials
ResourceDownload
Biological Respiratory Protection Program Grid
High Hazard Procedure Respiratory Protection Recommendations
SFDPH Interim Infection Control Recommendations for Healthcare Settings during an Infectious Disease Emergency or Bioterrorism Event
Environmental Cleaning Checklist
Infection Control and Social Distancing Strategies Overview
CDC Educational instructions on how to don and remove PPE
Instructions on Hand Hygiene
Guide for Developing Infection Control Recommendations
Instructions on Home Cleaning and Disinfecting
Evaluation for Home Stability for Isolation
Self Monitoring Lof for Exposed Workers to Known Respiratory Disease
Algorithm for Extended Dismissal of Students from Schools during Pandemic Influenza
Infection Control Strategies for an Unknown RAT Disease
Guidelines on Decontamination for Biological Agents
Infection Control for BDS (San Francisco)
BDS Decontamination Procedure (San Francisco)
Information about BDS Alert, Anthrax, and Decontamination (San Francisco)
United States Postal Service Critical Event/Individual Status Report
Epidemiology and Surveillance
Go Kits and Investigation Guidance
ResourceDownload
Disease Outbreak Investigation Plan
Foodborne Outbreak Investigation Guidance (CDC)
Go Kit - Enteric Outbreak
Go Kit - Rash and Respiratory Outbreak
Go Kits - Overview
Instructions for Donning PPE
Interview Guidance for a Criminal and Epidemiological Investigations
Steps of a Field Investigation
Investigation, Surveillance and Reporting Forms
ResourceDownload
Anthrax (Human) Case Report Form
Avian Influenza Screening Form
Avian Influenza Contact Monitoring Form
Botulism Case Report Form
Botulism Investigation Algorithm
Brucellosis (Undulant Fever)/ Q Fever/ Tularemia Case Report Form
Brucellosis Investigation Algorithm
Cholera and other Vibrio Illness Surveillance Report (CDC)
E. Coli Case Report Form
Plague Contact Management Algorithm
Plague Investigation Algorithm
Plague Contact Surveillance Form
Plague Individual Contact Surveillance Form
SARS Case Report Form
Smallpox Contact Management Algorithm
Smallpox Contact Surveillance Form
Smallpox Individual Contact Surveillance Form
Tularemia Investigation Algorithm
Unspecified Gastrointestinal Illness Case Investigation Form
Unspecified Fever Rash illness Outbreak Case Investigation Form
Unspecided Neurologic Illness Outbreak Case Investigation Form
Viral Hemorrhagic Fevers (VHF) Contact Management Algorithm
Viral Hemorrhagic Fevers (VHF) Contact Surveillance Form
Viral Hemorrhagic Fevers (VHF) Individual Contact Surveillance Form
Viral Hemorrhagic Fevers (VHF) Investigation Algorithm
Waterborne Disease Outbreak Report
Isolation and Quarantine
Documents for Home and Facility Isolation and Quarantine
ResourceDownload
Isolation Order Packet - San Francisco
Quarantine Order Packet - San Francisco
Fact Sheet on Isolation and Quarantine Legal Authority - State of California
Summary of State/Local Laws related to Isolation and Quarantine - San Francisco
Protocol on Legal Enforcement of Isolation and Quarantine - San Francisco
Protocol for Appeals Conference on Health Officer's Orders for Isolation and Quarantine - San Francisco
Instructionson Home Environmental Cleaning and Disinfection
Instructions on Handling of Eating Utensils, Laundry, and Wash
Status Report Template to Disease Containment Branch Director
Specimen Collection and Transporation Guidelines
Transportation of clients from Home or Non-Healthcare Facilties to Health Care Facilties for medical necessity
Transportation of clients from Home to other Facilities
Support Services Referral Form
Protocol for Post Exposure Prophylaxisdelivery and sign-off from clients
Protocol for HCW Self-Monitoring and Log for Disease Symptoms
Re-assessment/Checklist for Cessation of Isolation
Medical/Mental Health Referral Form
Home-Based Isolation and Quarantine Documents
ResourceDownload
Status Report Template to I&Q Group Supervisor - Home Isolation
Status Report Template to I&Q Group Supervisor - Home Quarantine
Evaluation for Home Suitability for Isolation and Quarantine
Instructions for Home Isolation
Instructions for Home Quarantine
Monitoring Log for Persons on Home Isolation
Monitoring Log for Persons on Home Quarantine
Transportation Protocol for Health Worker
Isolation and Quarantine Go-Kit Overview
Protocol for PPE and Infection Control Guidelines for IDER staff on Home Visits
Facility-Based Isolation and Quarantine Documents
ResourceDownload
Status Report Template to I&Q Group Supervisor - Non-HC Isolation
Status Report Template to I&Q Group Supervisor - Non-HC Quarantine
Criteria for Non-Healthcare Facility Based Isolation or Quarantine
Instructions for Non-Healthcare Facilties Based on Isolation
Instructions for Non-Healthcare Facilties Based on Quarantine
Initial Medical Admission Evaluation for Persons on Isolation Facility
Initial Medical Admission Evaluation for Persons on Isolation Quarantine
Monitoring Log for Persons on Non-Healthcare Facility Based Isolation
Monitoring Log for Persons on Non-Healthcare Facility Based Quarantine
Logistics
ResourceDownload
Staff Staging Area Manual - San Francisco DPH
Finance
ResourceDownload
Personnel Time Tracking Report Template
Procurement and Cost Unit Tracking Spreadsheet

 

Other Resources

The National Association of County and City Health Officials (NACCHO) and other Advanced Practice Centers have created a variety of resources to assist local health departments with emergency preparedness efforts. We've compiled a list of resources that relate to aspects of the Infectious Disease Emergency Response Toolkit.

 

 

 

Copyright © 2012 San Francisco Bay Area Advanced Practice Center
The San Francisco Bay Area Advanced Practice Center represents a partnership between the San Francisco Department of Public Health and the UC Berkeley Center for Infectious Diseases and Emergency Readiness.  This program is funded by the National Association of County and City Health Officials in collaboration with the Centers for Disease Control and Prevention.