Incident Missing Person Questionnaire

Transcription

1 Rescue Incident Name: Other Description Subject I.D. Interview Incident Missing Person Questionnaire Incident Form 1 of 5 Name of Interviewer: Source(s) of information (names relationships): (Use back page if needed) Name of missing person: Local Address: Home Address, if different: Nicknames/Aliases: Other important information: Age, Birthday, other: Height: Weight: Build: Hair Color: Hair Length: Sideburns? Beard? Moustache? Balding? Facial Features/Shape: Distinguishing Marks (scars, etc.): Race/Skin Color Complexion: General Appearance: Prepared: (circle one): phone in person phone in person Page 1 of 6

2 Incident Missing Person Questionnaire Clothing Hat? Color/Style? Shirt Color/Style: Sweater? Jacket? Style/Color? Pants/Skirt: Raingear? Gloves or Mittens? Sunglasses? Prescription Glasses? Shoes: Style, Color, Sole Type? Other Clothing? Scent Articles Available? Where? Equipment Pack? Br, Style, color? Tent? Color, Type, Br? Sleeping Bag? Color, Type, Br? Water Bottle/Canteen? Color/Type? Food? Brs, Amount? Flashlight? Br, Color, Battery Type? Matches? Wooden? Paper? Describe: Knife? Compass? Fishing Equipment? Money? Camera/Film/Accessories? Firearms? Gauge? Ammunition? Ice Axe/Skis/Snowshoes/Poles? Other Equipment? Trip Plans Trip Destination Purpose: Planned Route Alternate? Planned for Return: Group Affiliation? Transportation? Trip Starting Point Time: Car Description Location: Alternate Car or Alt. Pickup Plans: Page 2 of 6 6

3 Incident Missing Person Questionnaire Experience Last Seen Details When? Where? by Whom? (Name, Location, Phone): going Which Way? Weather? Special Reason for Leaving? Any Unusual Comments on Leaving? Familiar with the Area? Outdoor Experience Level? First Aid/Scout/Military? Hunting/Backpacking/Climbing? Ever been lost before? Where? When? Actions when lost before? Ever go out alone? Stay on trails or go cross-country? Contacts Who would subject contact on reaching civilization? (Name, Address, Phone) Include friends, relatives, habitual bars or restaurants Health General condition? Any physical hicaps or limitations? Psychological or psychiatric problems? Any medications? Amount carried? Consequences of loss? Eyesight without glasses/contacts? Carry spares? Physician/psychiatrist/counselor: Page 3 of 6

4 Incident Missing Person Questionnaire Personality Recreational drugs: What type/br? How much? Consequences of withdrawal? (include tobacco, alcohol, marijuana, cocaine, narcotics, prescription drugs) Particular outdoor interests? (e.g., "likes to follow streams because he's a fisherman") Job history? Recent problems at work or school? (confirm with co-workers or teachers) Relationship with spouse, family, or significant other(s)? Any recent changes? Closest relative? Closest other friend/confidant? Who had last significant conversation with subject? What about? When? Any recent mail that might be relevant? Religious preference beliefs? Priest, minister, or other religious leader who might provide information? History of problems with law? When? Locations where born/raised? History of depression? Ever run away from home? Leader or follower? Give up easily? Hole up wait, or keep going? Outgoing or quiet? Like to be alone? Likely response to searchers? Hitch-hike often? Page 4 of 6

5 Incident Missing Person Questionnaire For Children Fears: Dogs? Horses? Farm animals? Wild animals? Darkness? Being alone? Training for what to do if lost? Actions when hurt: Cry? Quiet withdrawn? Temper tantrums? Talk to strangers? Accept rides? Active or passive? For Groups For Groups Personality clashes? Any leader-types other than designated leader? How strong were group goals (making summit, getting to next shelter, etc.)? What actions would members take if separated? Names, contact info., experience of other members (Indicate if need for separate MPQ for any other members) Page 5 of 6

6 Incident Missing Person Questionnaire Attach picture(s), boot/shoe prints, scent articles as appropriate Page 6 of 6

7 Rescue Incident Name: 24-hour Local Time: Daily Comm Log Daily Form 1 of 10 Operational Period (): Major Events: IC Name(s): continue on reverse Page 1 of 2

8 24-hour Local Time: Daily Comm Log Major Events: Check here if more pages for this log: Page 2 of 2

9 Rescue Incident Name: Comm Agency Reps. Plans Logistics Incident Commer Daily Table of Organization Safety Officer Information Officer (Liaison Officer) Agency: Plans Chief Interviewer Resources (RESTAT) Situation (SITSTAT) (Documentation) (Demobilization) Logistics Chief (Support Director) (Supply) (Facilities) (Service Director) Communications Medical Food Daily Form 2 of 10 Operational Period (): Representative Name: Operations (Finance) Branch: Branch: Branch: Branch: (similar to ICS 203) Operations Chief Prepared: Director Director Director Director (Finance Chief) (Time) (Procurement) (Compensation/Claims) (Cost) Page 1 of 1

10 Rescue Daily SAR Unit/Government Personnel Register Daily Form 3 of 10 Incident Name: Name (Last, First, MI) Location: Organization Qualifications/ GSAR Level Date*: For this Date, Page: Arrival Time Estimated Departure Actual Departure of: Emergency Contact: Name Phone

11 Rescue Daily Local Volunteer Personnel Register Daily Form 4 of 10 Incident Name: Location: Name (Last, First, MI) Address Phone Number Date*: For this Date, Page: Arrival Time Estimated Departure Actual Departure of: Emergency Contact: Name Phone

12 Rescue Daily Vehicle Register Daily Form 5 of 10 Incident Name: Driver's Name (Last, First, MI) Location: Make/Type of Vehicle License Number State Date*: For this Date, Page: Point of Origin Arrival Time Estimated Departure Actual Departure of: (Estimated Round-Trip Mileage)

13 Rescue Incident Name: Task Number: Team Identifier: Daily Task Log Location: Team Type: Daily Form 6 of 10 Number on Team: Date*: Task: For this Date, Page : of: Time Out: Time In: (Total Hours) *Start new set of forms for each 24-hour period, midnight to midnight (1-page form)

14 Rescue Task Assignment Form Task No.: Task Map: Team ID: Team Type: Date/ Time Out: (Division): Task Assigned: Base Radio Dispatcher: Task Instructions: Personnel Assignment Transportation Instructions: Field Team Leader: Asst. FTL: Field Team Member: FTM: FTM: Special Equipment: FTM: FTM: FTM: Medic: Radio Op: FTM: Rescue Spec: Commo Team Callsign: Phone Numbers: Instructions: Channel/ Freq: Base Callsign: Channel/ Freq: Debrief Information on Back Page 1 of 2

15 Date/ Time In: Debriefing: Task Assignment Form Debriefing Officer: (Vehicle Miles): Debriefing Page 2 of 2 6