Ics 201 Form – Fill Out and Use This PDF

Block

Block Title

Instructions

Number

1

Incident Name

Enter the name assigned to the incident.

2

Incident Number

Enter the number assigned to the incident.

3

Date/Time Initiated

Enter date initiated (month/day/year) and time initiated (using the 24-

•

Date, Time

hour clock).

4

Map/Sketch (include sketch,

Show perimeter and other graphics depicting situational status,

showing the total area of

resource assignments, incident facilities, and other special information

operations, the incident

on a map/sketch or with attached maps. Utilize commonly accepted

site/area, impacted and

ICS map symbology.

threatened areas, overflight

If specific geospatial reference points are needed about the incident’s

results, trajectories, impacted

location or area outside the ICS organization at the incident, that

shorelines, or other graphics

information should be submitted on the Incident Status Summary (ICS

depicting situational status and

209).

resource assignment)

North should be at the top of page unless noted otherwise.

5

Situation Summary and

Self-explanatory.

Health and Safety Briefing (for

briefings or transfer of

command): Recognize potential

incident Health and Safety

Hazards and develop necessary

measures (remove hazard,

provide personal protective

equipment, warn people of the

hazard) to protect responders

from those hazards.

6

Prepared by

Enter the name, ICS position/title, and signature of the person

•

Name

preparing the form. Enter date (month/day/year) and time prepared

•

Position/Title

(24-hour clock).

•

Signature

•

Date/Time

7

Current and Planned

Enter the objectives used on the incident and note any specific problem

Objectives

areas.

Block

Block Title

Instructions

Number

8

Current and Planned Actions,

Enter the current and planned actions, strategies, and tactics and time

Strategies, and Tactics

they may or did occur to attain the objectives. If additional pages are

•

Time

needed, use a blank sheet or another ICS 201 (Page 2), and adjust

•

Actions

page numbers accordingly.

9

Current Organization (fill in

• Enter on the organization chart the names of the individuals

additional organization as

assigned to each position.

appropriate)

• Modify the chart as necessary, and add any lines/spaces needed for

Incident Commander(s)

•

Command Staff Assistants, Agency Representatives, and the

•

Liaison Officer

organization of each of the General Staff Sections.

•

Safety Officer

• If Unified Command is being used, split the Incident Commander

•

Public Information Officer

box.

•

Planning Section Chief

• Indicate agency for each of the Incident Commanders listed if

•

Operations Section Chief

Unified Command is being used.

•

Finance/Administration

Section Chief

•

Logistics Section Chief

10

Resource Summary

Enter the following information about the resources allocated to the

incident. If additional pages are needed, use a blank sheet or another

ICS 201 (Page 4), and adjust page numbers accordingly.

•

Resource

Enter the number and appropriate category, kind, or type of resource

ordered.

•

Resource Identifier

Enter the relevant agency designator and/or resource designator (if

any).

•

Date/Time Ordered

Enter the date (month/day/year) and time (24-hour clock) the resource

was ordered.

•

ETA

Enter the estimated time of arrival (ETA) to the incident (use 24-hour

clock).

•

Arrived

Enter an “X” or a checkmark upon arrival to the incident.

•

Notes (location/

Enter notes such as the assigned location of the resource and/or the

assignment/status)

actual assignment and status.