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S-SV EMS Agency
Butte, Colusa, Glenn, Nevada, Placer, Shasta, Siskiyou, Sutter, Tehama & Yuba Counties
(916) 625-1702
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REGION III OA SITUATION REPORT
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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
*
--- Select Choice ---
Initial
Update
Final
Report Status
*
--- Select Choice ---
Advisory: No Action Required
Alert: Action Required
Report Creator Information
Title/Position
*
--- Select Choice ---
MHOAC
MHOAC Designee
Other
Name
*
Organization
*
Contact Telephone Number
*
Contact Email
*
Incident Information
Operational Area (OA)
*
Select One
Butte
Colusa
Glenn
Lassen
Modoc
Plumas
Shasta
Sierra
Siskiyou
Sutter
Tehama
Trinity
Yuba
Incident Name
*
Incident Location
*
Incident Date / Time
*
Date
Time
Incident Type
*
Select One
Chemical/Biological/Radiological/Nuclear (CBRN)
Civil Unrest
Disease Outbreak
Drinking Water
Earthquake
Explosion/Fire
Flood
Food/Agriculture
Healthcare Facility Evacuation
Multiple Casualty Incident (MCI)
Patient Surge
Power Outage
Public Safety Power Shutoff (PSPS)
Weather Related (Extreme Temperatures/Severe Weather)
Wildland Fire
Other (Please Explain Below)
'Other' Incident Type Explanation
Shelter Information
Is there a shelter open in your OA?
*
--- Select Choice ---
No
Yes
Is your OA providing a shelter(s) for a neighboring OA?
No
Yes
Number of shelters in 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
Refer to the CA Public Health & Medical Emergency Operations Manual: https://www.cdph.ca.gov/Programs/EPO/CDPH%20Document%20Library/FinalEOM712011.pdf
Current OA Medical/Health System Condition
*
--- Select Choice ---
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
*
--- Select Choice ---
No Change
Improving
Worsening
Current Situation Summary
*
Current Priorities
*
Critical Issues/Actions Taken
*
Are there any medical/health needs?
*
--- Select Choice ---
No
Yes
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?
Submit
