Hics 203-Organization Assignment List

HICS 203 ORGANIZATION ASSIGNMENT LIST
1. Incident Name
2. Operational Period (#
POSITION
DATE:
FROM: __________________________ TO: __________________________
TIME:
FROM: __________________________ TO: __________________________
NAME
CONTACT INFO (PHONE, CELL, RADIO)
3. Incident Commander(s) and Staff

Incident Commander
Public Information Officer
Liaison Officer
Safety Officer
Medical-Technical Specialist:
4. Operations Section
Operations Chief
Staging Manager
Medical Care Branch Director
Infrastructure Branch Director
Security Branch Director
Hazardous Materials Branch Director
Business Continuity Branch Director
Patient Family Assistance Director
Others if needed
5. Planning Section
Planning Chief
Resources Unit Leader
Situation Unit Leader
Documentation Unit Leader
Demobilization Unit Leader
6. Logistics Section
Logistics Chief
Service Branch Director
Support Branch Director
7. Finance / Administration Section
Finance/Administration Chief
Time Unit Leader
Procurement Unit Leader
Compensation/Claims Unit Leader
Cost Unit Leader
8. Agency Executive
9. External Agency Representative
(in the Hospital Command Center)
10. Hospital Representative (in the external
Emergency Operations Center)
11. Prepared by
PRINT NAME: __________________________________________________
SIGNATURE: _____________________________________________
DATE/TIME: ____________________________________________________
FACILITY: ________________________________________________
Purpose:
List person assigned to Hospital Incident Management Team (HIMT) position
Origination: Planning Section Chief or designee (Resources Unit Leader)
Copies to: Command Staff, Section Chiefs, Branch Directors, and Documentation Unit Leader
Purpose: Provide Cover Sheet and checklist for each Operational Period Incident Action Plan.
Origination: Incident Commander or Planning Chief.
Copies to: Command Staff, Section Chiefs, and Documentation Unit Leader
HICS 203 | Page 1 of 1
HICS 203 ORGANIZATION ASSIGNMENT LIST

PURPOSE:
The HICS 203 - Organization Assignment List provides Hospital Incident Management Team
(HIMT) personnel with information on the positions that are currently activated and the names
of personnel staffing each position.
ORIGINATION:
The Planning Section Chief or designee (Resources Unit Leader) prepares and maintains the
currency of the list. Complete only the blocks for the positions that are activated for the
incident. If a trainee is assigned to a position, indicate this with a T in parentheses behind
the name (e.g., A. Smith (T)).
COPIES TO:
Duplicate and provide to all recipients as part of the Incident Action Plan (IAP). All completed
original forms must be given to the Documentation Unit Leader.
NOTES:
For all individuals, use at least the first initial and last name. If there is a shift change or
other reason during the specified operational period, list both names, separated by a slash.
If assigned, document Assistants / Deputies to Command staff as needed or resources allow.
If additional pages are needed for any form page, use a blank HICS 203 and repaginate as
needed. Additions may be made to the form to meet the organizations needs.
NUMBER
1
TITLE
Incident Name
Operational Period
Enter the start date (m/d/y) and time (24-hour clock) and end
date and time for the operational period to which the form
applies.
Incident Commander(s)
and Command Staff
Enter the names and contact information. For Unified Command,

also include agency names.
Operations Section
Enter the names and contact information.
Planning Section
Logistics Section
Finance / Administration
Section
Agency Executive
External Agency
Representative
Enter the external agency/organization names present in the

Hospital Command Center (HCC) and the names of their
representatives.
10
Hospital Representative
Enter the names and role of hospital personnel in the local

emergency operations center (EOC), and local EOC location.
11
Prepared by
Enter the name and signature of the person preparing the form.
Enter date (m/d/y), time prepared (24-hour clock), and facility.
INSTRUCTIONS
Enter the name assigned to the incident.
Enter the name and contact information of the executive (e.g.,

Chief Executive Officer) with whom the Incident Commander
interfaces.
HICS 2014
Purpose: Provide Cover Sheet and checklist for each Operational Period Incident Action Plan.
Origination: Incident Commander or Planning Chief.
Copies to: Command Staff, Section Chiefs, and Documentation Unit Leader

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HICS 203 ORGANIZATION ASSIGNMENT LIST

FROM: TO:

FROM: TO:

CONTACT INFO (PHONE, CELL, RADIO)

3. Incident Commander(s) and Staff

PRINT NAME: __________________________________________________

HICS 203 | Page 1 of 1

HICS 203 ORGANIZATION ASSIGNMENT LIST

Enter the names and contact information. For Unified Command,

Enter the names and contact information.

Enter the names and contact information.

Enter the names and contact information.

Enter the names and contact information.

Enter the external agency/organization names present in the

Enter the names and role of hospital personnel in the local

Enter the name and contact information of the executive (e.g.,

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