REGION III OA SITUATION REPORT

Notice: A copy of the completed form will also be sent to the 'Contact Email' address entered below.

Region III RDMHS Duty Officer Contact Information:
• Phone: (916) 625-1709
• Email: RDMHS.REGION3@ssvems.com

Report Type *

Initial
Update
Final

Report Status *

Advisory: No Action Required
Alert: Action Required

Report Creator Information

Title/Position *

MHOAC
MHOAC Designee
Other

Name *

Organization *

Contact Telephone Number *

Contact Email *

Incident Information

Operational Area (OA) *

Incident Name *

Incident Location *

Incident Date / Time *

Date

Time

Incident Type *

'Other' Incident Type Explanation

Shelter Information

Is there a shelter open in your OA? *

Yes
No

Is your OA providing a shelter(s) for a surrounding OA? *

Yes
No

Number of shelters within your OA

Shelter locations within your OA

Who is managing the shelter(s) in your OA?

American Red Cross (ARC)
Operational Area (OA)
Combination

Additional Shelter Notes/Comments

Current Shelter Census

Please describe shelter status (AFN, communicable disease outbreaks, animal shelters, etc.)

Current Situation Status Information

Current OA Medical/Health System Condition *

GREEN - Normal Operations
YELLOW - Under control, NO assistance required
ORANGE - Assistance from within OA required
RED - Some assistance required from outside OA
BLACK - Significant assistance required from outside OA
GREY - Unknown, conducting assessments

Situation Prognosis *

No Change
Improving
Worsening

Current Situation Summary *

Current Priorities *

Critical Issues/Actions Taken *

Are there any medical/health needs? *

Yes
No

Please describe unmet medical/health needs

Cal OES Health & Medical Resource Request System (HAMRRS) website: https://engage.caloes.ca.gov/s/login/

Any additional incident notes/details?

S-SV EMS Agency