Documents

Resources, Documents, and Templates

• Appendix A CMS Emergency Preparedness Checklist for Effective Healthcare Facility Planning
• Appendix B Hazard Vulnerability Analysis tool
• Appendix C ICS Organization chart, job action sheets, and ICS Quick start guide
• Appendix D Facility Contact Lists
• Appendix E Facility Specific Information
• Appendix F HIPAAWaiverToolkit
• Appendix G Evacuation Plan and Checklists, and Transportation agreements
• Appendix H Facility Shelter in Place plan, Supply and Equipment lists, and checklists
• Appendix I MOU Templates
• Appendix J Recovery Checklists
• Appendix K Staff Care Plan documentation
• Appendix L Exercise, Evaluation, and Improvement planning checklist and AAR
• Appendix M Regional Resources and Contacts
• Annex A: Apartment Evacuation Policy & Procedure
• Annex B: Behavior Health
• Annex C: Bioterrorism Threats
• Annex D: Bomb Threat Policy and Procedure
• Annex E: Chemical Spills
• Annex F: Communication Plan
• Annex G: Electrical Power Outage Policy and Procedure
• Annex H: Elevator Policy and Procedure
• Annex I: Emergency Notification of Administrator
• Annex J: Fire Policy & Procedure
• Annex K: Heat and Humidity Policy and Procedure
• Annex L: Loss of Telephone Service Policy and Procedure

MDCH – LTC Disaster Planning Resources