Elevating the Post-Acute and
Long Term Care Profession

Nursing Home Incident Command System Forms

We would like to thank the California Association of Health Facilities (CAHF) for their use of grant-funded resources to adapt and expand the Hospital  Incident Command System materials for the benefit of nursing facilities and other long-term care service providers.

Nursing Home Incident Command System (NHICS) documents from the American Health Care Association and the California Association of Health Facilities (CAHF) are exclusively intended to provide information and guidance. They do not contain or constitute legal advice in any form and do not make any assurance or representation that the information and guidance contained herein will be determined to constitute compliance with state or federal law, regulation, or guidance.


NHICS Guidebook (Download PDF)
Attachment A: NHICS Incident Management Team Chart (Download PDF)
Attachment B: NHICS Quick Guideline to Job Responsibilities & Authorities (Download PDF)
Attachment C: NHICS Position Crosswalk (Download PDF)



Operations Section:


NHICS 201: Incident Briefing and Operational LogDownload PDF Download Word
NHICS 202: Incident ObjectivesDownload PDF Download Word
NHICS 203: Organization Assignment ListDownload PDF Download Word
NHICS 205: Incident Communications PlanDownload PDF Download Word
NHICS 206: Staff Injury PlanDownload PDF Download Word
NHICS 207: Organizational ChartDownload PDF Download Word
NHICS 213: Incident Message FormDownload PDF Download Word
NHICS 251: Facility System Status ReportDownload PDF Download Word
NHICS 252: Section Personnel Time SheetDownload PDF Download Word
NHICS 253: Volunteer Staff RegistrationDownload PDF Download Word
NHICS 254: Master Emergency Admit Tracking FormDownload PDF Download Word
NHICS 255: Master Resident Evacuation Tracking FormDownload PDF Download Word
NHICS 256: Procurement Summary ReportDownload PDF Download Word
NHICS 257: Resource Accounting RecordDownload PDF Download Word
NHICS 258: Facility Resource DirectoryDownload PDF Download Word
NHICS 259: Master Facility Casualty & Fatality ReportDownload PDF Download Word
NHICS 260: Individual Resident Evacuation Tracking FormDownload PDF Download Word
NHICS 261: Incident Action Safety AnalysisDownload PDF Download Word


 

    

With Support from OHCA Champion Partners