OFFICE OF THE CHIEF OF POLICE

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1 OFFICE OF THE CHIEF OF POLICE ADMINISTRATIVE ORDER NO. 1 Septeber 16, 215 SUBJECT: INCIDENT COMMAND SYSTEM FORMS ACTIVATED PURPOSE: The Incident Coand Syste (ICS) uses a series of standard fors, which have been developed by the National Incident Manageent Syste (NIMS), Federal Eergency Manageent Agency (FEMA). These fors convey directions for the accoplishent of objectives and for the distribution of inforation. This Order activates seven official Departent ICS fors. PROCEDURE: The following ICS Fors have been activated and assigned with Departent for nubers: I. SUPPORT VEHICLE/EQUIPMENT INVENTORY (ICS 218), FORM This for is used and aintained by the Ground Support Unit to provide an inventory of all transportation and support vehicles and equipent assigned to an incident. The Resources Unit also utilizes this inforation to initiate and aintain status/resource inforation. II. III. AIR OPERATIONS SUMMARY (ICS 22), FORM This for is used to provide the Air Operations Branch with the nuber, type, location, and specific assignents of helicopters and air resources. INCIDENT OPEN ACTION TRACKER (ICS 233), FORM This for is used by the Incident Coander/Unified Coand (IC/UC) to assign and track tasks/actions to Incident Manageent Tea (IMT) personnel that do not rise to the level of being an Incident Objective. IV. FACILITY NEEDS ASSESSMENT WORKSHEET (ICS 235), FORM This for is used as a planning tool to develop the Incident Coand Post (ICP) plan in a structured and disciplined anner. V. SAFETY MESSAGE/PLAN (ICS 28), FORM This for is used to expand on the Safety Message and Site Safety Plan by the Safety Officer for the Incident Action Plan (IAP). VI. GENERAL MESSAGE (ICS 213), FORM This for is used by the incident dispatchers to record incoing essages that cannot be orally transitted to the intended recipients. This for is also used by the ICP and other incident personnel to transit essages (e.g., resource order, incident nae change, other ICS coordination issues) to the Incident Counications Center for transission via radio or telephone to the addressee. Additionally, this for is used to send any essage or notification to incident personnel that requires hard-copy delivery.

2 ADMINISTRATIVE ORDER NO Septeber 16, 215 VII. INCIDENT ACTION PLAN SAFETY ANALYSIS (ICS 215A), FORM This for is used to aid the Safety Officer in copleting an operational risk assessent to prioritize safety and health issues, and to develop appropriate controls. This for addresses counications challenges between planning and operations, and is best utilized in the planning phase and for Operations Section briefings. For copletion and distribution of these fors, please refer to Volue 2 of the Eergency Operations Guide. FORM AVAILABILITY: The Support Vehicle/Equipent Inventory (ICS 218); Air Operations Suary (ICS 22); Incident Open Action Tracker (ICS 233); Facility Needs Assessent Worksheet (ICS 235); Safety Message/Plan (ICS 28); General Message (ICS 213); and, Incident Action Plan Safety Analysis (ICS 215A) are attached for iediate use and duplication and are available in E-Fors on the Departent's Local Area Network. The "For Use" link applicable to the activated ICS fors has been updated. AUDIT RESPONSIBILITY: The Coanding Officer, Audit Division, shall review this directive and deterine whether an audit or inspection shall be conducted in accordance with Departent Manual Section /8.3. CHARLIE BECK Chief of Police Attachents DISTRIBUTION "D"

3 SUPPORT VEHICLE/EQUIPMENT INVENTORY (ICS 218) 1. Incident Nae: 2. Incident Nuber: 3. Date/Tie Prepared: Date: Tie: 4. Vehicle/Equipent Category: 5. Vehicle/Equipent Inforation: Order Request Nuber Incident ID Nuber Vehicle or Equipent Classification Vehicle or Equipent Make Category/ Kind/Type, Capacity, or Size Vehicle or Equipent Features Agency or Owner Operator Nae or Contact Vehicle License or ID Nuber Incident Assignent Incident Start Date and Tie Incident Release Date and Tie 6. Prepared by: Nae/Serial No.: Position/Title: Signature: LAPD ICS (7/15)

4 AIR OPERATIONS SUMMARY (ICS 22) 1. Incident Nae: 2. Operational Period: Start Date: Start Tie: 4. Rearks (Safety notes, hazards, air operations special equipent, etc.): End Date: End Tie: 5. Ready Alert Aircraft: Medivac: New Incident: 3. Sunrise: Sunset: 6. Teporary Flight Restriction Nuber: Altitude: Center Point: 8. Frequencies: AM FM 9. Fixed-Wing (category/kind/type, ake/odel, N#, base): Air/Air Fixed-Wing Air Tactical Group Supervisor Aircraft: 7. Personnel: Nae: Phone Nuber: Air Operations Branch Director Air Support Group Supervisor Air Tactical Group Supervisor Helicopter Coordinator Helibase Manager Air/Air Rotary-Wing - Flight Following Air/Ground Coand Deck Coordinator Take-Off & Landing Coordinator Air Guard Other Fixed-Wing Aircraft: 1. Helicopters (use additional sheets as necessary): FAA N# Category/Kind/Type Make/Model Base Available Start Rearks 11. Prepared by: Nae/Serial No.: Position/Title: Signature: Date/Tie: LAPD ICS 22 Page (7/15)

5 AIR OPERATIONS SUMMARY (ICS 22). Incident Nae: 2. Operational Period: Start Date: Start Tie: End Date: End Tie: 3. Sunrise: Sunset: 12. Task/Mission/Assignent (category/kind/type and function includes: air tactical, reconnaissance, personnel transport, search and rescue, etc.): Category/Kind/Type and Function Nae of Personnel or Cargo (if applicable) or Instructions for Tactical Aircraft Mission Start Fly Fro Fly To 11. Prepared by: Nae/Serial No.: Position/Title: Signature: Date/Tie: LAPD ICS 22 Page (7/15)

6 INCIDENT OPEN ACTION TRACKER (ICS 233) 1. Incident Nae: 2. No. 3. Ite: 4. For/POC: Briefed POC (X): 6. Start Date: 7. Status: 8. Target Date: 9. Actual Date: LAPD ICS (7/15)

7 6 Ci) N co 1 6. Date/Tie Prepared: Nae/Serial No.: Position/Title: Signature: 5. Prepared By: 7J 7 7 MMMMM 1 Staging 7J L 5 L 5 Base Base Coon Areas 7 Finance/Adin Section Logistics Section 7J Operations Section 7J Planning Section Pj n1 Public Inforation Officer Safety Officer PO Liaison Officer & Agency Reps 5 - Unified Coand 2. Location 3. Facilities 1. Incident Nae: 7J o r..«z c:. 2 ca,_. c- 7J # Expected Personnel Internal/Building Workspace Sq Ft (8 sq ftlpers) Wall Space Linear Sq Ft Multi-Purpose Mgt R Sq Ft (2 sq ftipers + display space) External/Outside Laydown Sq Ft Parking Space Sq Ft (12 sq ft/vehicle X 1.4 circulation factor) Cliate Control (HVAC) Needed - yes/no Toilet Roos Work Tables Conference Table Chairs Telephones Speaker Phone Fax Machines Power Outlets Cop Workstations Printers > o, 1 II z rn rn (i) > cp cf) co cn g z Chart Printer/ChartPro Video Projectors Copy Machines Paper Shredders (si./lo) sc oz t7l.

8 SAFETY MESSAGE/PLAN (ICS 28) 1. Incident Nae: 2. Operational Period: Start Date: Start Tie: 3. Safety Message/Expanded Safety Message, Safety Plan, Site Safety Plan: End Date: End Tie: 4. Site Safety Plan Required? Yes 71 Approved Site Safety Plan(s) Located at: 5. Prepared by: Nae/Serial No.: No E Position/Title: Date/Tie: Signature: LAPD ICS 28, IAP Page (7/15)

9 GENERAL MESSAGE (ICS 213) 1. Incident Nae (Optional): 2. To (Nae and Position) : 3. Fro (Nae and Position) : 4. Subject: 5. Date: 6. Tie: 7. Message: 8. Approved by: Nae/Serial No.: Position/Title: Signature: 9. Reply: 1. Replied by: Nae/Serial No.: Position/Title: Signature: Date/Tie: LAPD ICS (7/15)

10 INCIDENT ACTION PLAN SAFETY ANALYSIS (ICS 215A) 1. Incident Nae: 2. Incident Nuber: 3. Date/Tie Prepared: 4. Operational Period: Start Date: End Date: Date: Tie: Start Tie: End Tie: 5. Incident Area 6. Hazards/Risks 7. Mitigations 8. Prepared by: (Safety Officer): Nae/Serial No.: (Operations Section Chief): Nae/Serial No.: Signature: Signature: Date/Tie: LAPD ICS 215A (7/15)