Ics 208 Hm Form PDF Details

In the realm of hazardous materials management and emergency response, the preparation and implementation of thorough safety and control plans are non-negotiable. Within this context, the ICS 208 HM form emerges as a critical document, designed to establish a coherent and comprehensive Site Safety and Control Plan. Essential for any hazardous material incident response, this form captures a wide array of information, from basic incident details such as name, date, and location, to more complex aspects including specific roles within the incident command system, hazardous material identification, risk analysis, and detailed decontamination procedures. Moreover, it stipulates communication protocols, medical assistance readiness, a site map indicating strategic operational zones, and entry objectives alongside standard operating procedures (SOPs) and safe work practices. The form also outlines emergency procedures, ensuring those involved are well-prepared for any eventualities. The meticulous completion and review of the ICS 208 HM by the Hazardous Materials Group Supervisor and relevant personnel, prior to operations within the Exclusion Zone, underscore its significance in safeguarding the safety of responders and the public during hazardous materials incidents.

QuestionAnswer
Form NameIcs 208 Hm Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesics 208 location, ics hm 4, plan ics 208, ics 208 fillable form

Form Preview Example

 

SITE SAFETY AND

1.

 

Incident Name:

 

 

2.

Date Prepared:

 

 

3.

 

Operational Period:

 

CONTROL PLAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Time:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ICS 208 HM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section I. Site Information

 

 

 

 

 

 

 

 

 

 

 

 

4.

Incident Location:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section II. Organization

 

 

 

 

 

 

 

 

 

 

 

 

5.

Incident Commander:

 

 

 

6.

HM Group Supervisor:

 

 

7.

Tech. Specialist - HM Reference:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

Safety Officer:

 

 

 

9.

Entry

Leader:

 

 

 

10.

Site Access Control Leader:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

Asst. Safety Officer - HM:

 

 

 

12.

Decontamination Leader:

 

 

13.

Safe Refuge Area Mgr:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

Environmental Health:

 

 

 

15.

 

 

 

 

 

 

 

 

16.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

Entry Team: (Buddy System)

 

 

 

 

 

 

 

18.

Decontamination Element:

 

 

 

 

 

 

 

 

 

Name:

 

 

 

 

PPE Level

 

 

 

 

 

 

 

Name:

 

 

 

PPE Level

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Entry 1

 

 

 

 

 

 

 

Decon 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Entry 2

 

 

 

 

 

 

 

Decon 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Entry 3

 

 

 

 

 

 

 

Decon 3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Entry 4

 

 

 

 

 

 

 

Decon 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section III. Hazard/Risk Analysis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19.

Material:

 

 

Container

Qty.

 

Phys.

 

pH

IDLH

F.P.

I.T.

V.P.

V.D.

 

S.G.

 

LEL

UEL

 

 

 

 

 

type

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV. Hazard Monitoring

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20.

LEL Instrument(s):

 

 

 

 

 

 

 

21.

O2

Instrument(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22.

Toxicity/PPM Instrument(s):

 

 

 

 

 

 

 

23.

Radiological Instrument(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section V. Decontamination Procedures

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24.

Standard Decontamination Procedures:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES:

 

 

 

NO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section VI. Site Communications

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25.

Command Frequency:

 

 

 

26.

Tactical Frequency:

 

 

27.

Entry Frequency:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section VII. Medical Assistance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28.

Medical Monitoring:

 

YES:

 

NO:

 

 

29. Medical Treatment and Transport In-place:

 

 

YES:

 

NO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ICS 208 HM

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Section VIII. Site Map

30. Site Map:

Weather ❏ Command Post ❏

Zones ❏

Assembly Areas ❏

Escape Routes ❏

Other ❏

Section IX. Entry Objectives

31. Entry Objectives:

Section X. SOP S and Safe Work Practices

32. Modifications to Documented SOP s or Work Practices:

YES:

NO:

 

 

 

Comment:

 

 

Section XI. Emergency Procedures

33. Emergency Procedures:

 

Section XII.

Safety Briefing

 

 

 

 

34.

Asst. Safety Officer - HM Signature:

 

Safety Briefing Completed (Time):

 

 

 

 

35.

HM Group Supervisor Signature:

 

36. Incident Commander Signature:

 

 

 

 

ICS 208 HM

Page 2

3/98

INSTRUCTIONS FOR COMPLETING THE SITE SAFETY AND CONTROL PLAN

ICS 208 HM

A Site Safety and Control Plan must be completed by the Hazardous Materials Group Supervisor and reviewed by all

within the Hazardous Materials Group prior to operations commencing within the Exclusion Zone.

Item Number

Item Title

Instructions

 

1.

Incident Name/Number

Print name and/or incident number.

2.

Date and Time

Enter date and time prepared.

3.

Operational Period

Enter the time interval for which the form applies.

4.

Incident Location

Enter the address and or map coordinates of the incident.

5 - 16.

Organization

Enter names of all individuals assigned to ICS positions. (Entries 5 &

 

 

8 mandatory). Use Boxes 15 and 16 for other functions: i.e. Medical

 

 

Monitoring.

 

17 - 18.

Entry Team/Decon

Enter names and level of PPE of Entry & Decon personnel. (Entries 1

 

Element

- 4 mandatory buddy system and back-up.)

19.

Material

Enter names and pertinent information of all known chemical

 

 

products.

Enter UNK if material is not known. Include any which

 

 

apply to chemical properties. (Definitions: ph = Potential for Hydrogen

 

 

(Corrosivity), IDLH = Immediately Dangerous to Life and Health,

 

 

F.P. = Flash Point, I.T. = Ignition Temperature, V.P. = Vapor Pressure,

 

 

V.D. = Vapor Density, S.G. = Specific Gravity, LEL = Lower Explosive

 

 

Limit, UEL = Upper Explosive Limit)

20 - 23.

Hazard Monitoring

List the instruments which will be used to monitor for chemical.

24.

Decontamination

Check NO

if modifications are made to standard decontamination

 

Procedures

procedures and make appropriate Comments including type of

 

 

solutions.

 

25 - 27.

Site Communications

Enter the radio frequency(ies) which apply.

28 - 29.

Medical Assistance

Enter comments if NO is checked.

30.

Site Map

Sketch or attach a site map which defines all locations and layouts of

 

 

operational zones. (Check boxes are mandatory to be identified.)

31.

Entry Objectives

List all objectives to be performed by the Entry Team in the

 

 

Exclusion Zone and any parameters which will alter or stop entry

 

 

operations.

 

32 - 33.

SOP s, Safe Work

List in Comments if any modifications to SOP s and any emergency

 

Practices, and

procedures which will be affected if an emergency occurs while

 

Emergency

personnel are within the Exclusion Zone.

 

Procedures

 

 

34 - 36.

Safety Briefing

Have the appropriate individual place their signature in the box once

 

 

the Site Safety and Control Plan is reviewed.

 

 

Note the time in box 34 when the safety briefing has been completed.

ICS 208 HM

Page 3

3/98

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1. The ics 208 location necessitates specific details to be typed in. Ensure the subsequent blank fields are finalized:

How one can complete ics hm 4 portion 1

2. Your next step is usually to fill out the following blank fields: type, State, Comment, LEL Instruments, O Instruments, Section IV Hazard Monitoring, ToxicityPPM Instruments, Radiological Instruments, Comment, Standard Decontamination, Comment, Section V Decontamination, YES, and Section VI Site Communications.

Writing part 2 in ics hm 4

3. In this particular part, review Command Frequency, Tactical Frequency, Entry Frequency, Section VI Site Communications, Section VII Medical Assistance, Medical Monitoring, YES, Medical Treatment and Transport, YES, Comment, ICS HM, and Page. These have to be completed with highest accuracy.

Section VI Site Communications, YES, and Section VII Medical Assistance inside ics hm 4

4. The form's fourth subsection comes with these particular blanks to fill out: Site Map.

ics hm 4 writing process outlined (part 4)

When it comes to Site Map and Site Map, be certain you double-check them here. Both of these are viewed as the key ones in the file.

5. The final point to finalize this document is pivotal. Make certain to fill out the mandatory blanks, which includes Weather, Command Post, Zones, Assembly Areas, Escape Routes, Other, Section IX Entry Objectives, Entry Objectives, Modifications to Documented SOP s, YES, Section X SOP S and Safe Work, Comment, Emergency Procedures, Section XI Emergency Procedures, and Asst Safety Officer HM Signature, prior to finalizing. Neglecting to accomplish that might give you a flawed and potentially nonvalid paper!

Filling out section 5 in ics hm 4

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