Standard Operating Guides
Health and medical Standard Operating Guides (SOG), Standard Operating Procedures (SOP) and Emergency Operations Plans (EOP) are guidance documents for how an agency will respond during a time of emergency. The templates below can be used by local health and medical agencies to develop emergency response plans. Each template includes a base document (plan, SOG or SOP) and supporting material (Annexes, Attachments, etc) which are to be modified to become agency specific.
Biological Incident Annex
The Biological Incident Annex (BIA) outlines the actions, roles and responsibilities associated with response to a disease outbreak of known or unknown origin requiring State assistance. Actions described in this annex take place with or without a declared emergency. This annex applies only to incidents of State or National significance. This annex outlines biological incident response actions including threat assessment notification procedures, laboratory testing, joint investigative/response procedures, management of the Strategic National Stockpile and activities related to recovery. Specific, detailed information is maintained in the KDHE Internal Operating Procedures for a BIA activation. The link below will direct the user to Kansas’ secure online planning application. Please note, new users to NetEOP will need to contact their county Emergency Manager to gain access.
Chain of Custody SOG and Laboratory Information
The Chain of Custody standard operating guide (SOG) provides guidance on how to fill out the Multi-patient Clinical Specimen Evidence Chain of Custody Receipt form.
Community Alternate Care Site
The Alternate Care Site (ACS) Emergency Operations Plan (EOP) is intended to enhance community plans for managing a disaster that creates a surge of patients beyond community capabilities by providing additional facility care to ill patients who would otherwise seek care at hospitals and community health centers. The purpose of this plan is to provide operational concepts unique to alternate care site response, document coordination, and enhance response efforts when responding to community healthcare demands.
- Community Alternate Care Site Template (.doc)
- Supporting Documents
- Additional Planning Resources
Community Disease Containment SOG
The Community Disease Containment SOG provides counties with step-by-step instructions for reducing or minimizing person-to-person spread of disease by separating individuals with disease or at increased risk for developing disease from individuals at lower risk.
- County Community Disease Containment SOG template (.doc)
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Supporting Documents
- Attachment 1 – Toolbox (pdf)
- Attachment 2 – ICS Charts
- Attachment 3 – Emergency Call Down Roster (doc)
- Attachment 4 – Point of Contact List (doc)
- Attachment 5 – Job Action Sheets (doc)
- Attachment 6 – Priority Prophylaxis and Vaccination Distribution (doc)
- Attachment 7 – Pre-identified Isolation and Quarantine Facilities (doc)
- Attachment 8 – Language Line Information Sheet (doc)
- Additional Planning Resources
Community Mental Health Center Plan Template
Kansas has developed a plan template that describes the organization, scope and expectations for provision of disaster preparedness and response activities in order to provide CMHC’s the information necessary to develop their own unique all-hazards response plan. These plans will describe the local agency’s responsibilities, area resources for disaster response and community coordination of disaster responses.
Dialysis Center Plan Template
This template is provided by KDHE and is a general emergency management plan for any dialysis center. This emergency management plan includes provisions to ensure the life safety of employees, patients, and visitors, assure availability of dialysis care, protect electronic and hard copy clinical and business records (data and paper critical records), mitigate damage to property and contents and return to normal operations as soon as possible.
- Dialysis Facility Disaster Plan Template (.doc)
- Supporting Documents
- Additional Planning Resources
EMS Planning Guidance
This document provides guidance to organizations and personnel starting the emergency planning process for the first time and to those reviewing or updating existing plans. The steps outlined in this document represent a very simplified approach to emergency planning.
- EMS Planning Guidance (.pdf)
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Additional Planning Resources
- EMS Best Practices Synopsis (.pdf)
- Kansas CHEMPACK Plan (.pdf)
- Kansas. Dept. of Social and Rehabilitation Services (SRS) Disaster Response
- Interim Guidance for Cleaning EMS Transport Vehicles during an Influenza Pandemic – PandemicFlu.gov
- Kansas Board of EMS
- EMS.gov – NHTSA Office of Emergency Medical Services
Emergency Support Function (ESF) 8 Plan
The local Emergency Support Function (ESF) 8 – Health and Medical annex to the county Emergency Operations Plan provides information related to health and medical activities conducted in response to any incident. This annex describes actions by county health and medical partners in support of incident response. The link below will direct the user to Kansas’ secure online planning application.
Fatality Management Information
Management of the dead is one of the most difficult aspects of disaster response, and natural disasters, in particular, can cause a large number of deaths. Although the humanitarian community has been aware of these challenges for over 20 years, the massive loss of life following the South Asian tsunami in 2004 highlighted limitations in our current capacity to respond. Several large natural disasters in 2005, including Hurricane Katrina in the United States, Hurricane Stan in Central America, and the earthquake in Northern Pakistan and India, further reveal the need for practical guidance.
Hospital COOP
The purpose of the COOP plan is to establish policy and guidance to ensure that essential functions for hospitals are continued in the event that manmade, natural, or technological emergencies disrupt or threaten to disrupt normal operations. The COOP plan enables the hospital to operate with a significantly reduced workforce and diminished availability of resources, and to operate from an alternate work site should the primary facility become uninhabitable.
Hospital EOP
This Emergency Operations Plan (EOP) is based on the Hospital Incident Command System (HICS). The base plan discusses overall incident management and operations for hospitals during response to emergencies. Supporting annexes provide detailed operational guidance based on incident functions.
- Hospital Emergency Operations Planning Template (.doc)
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Supporting Documents
- Annex A – Patient Surge
- Annex B – Security
- Annex C – Evacuation
- Annex D – HAZMAT (doc)
- Annex E – Shelter in Place
- Annex F – Resource Directory
- Annex G – Job Action Sheets
- Job Action Sheets Introduction (doc)
- Command Staff
- Finance Administration
- Logistics
- Communications Unit Leader (doc)
- Employee Health & Well Being Unit Leader (doc)
- Facilities Unit Leader (doc)
- Family Care Unit Leader (doc)
- Logistics Information Technology Unit Leader (doc)
- Labor Pool Credentialing Unit Leader (doc)
- Logistics Section Chief (doc)
- Service Branch Director (doc)
- Staff Food & Water Unit Leader (doc)
- Supply Unit Leader (doc)
- Support Branch Director (doc)
- Transportation Unit Leader (doc)
- Operations
- Operations Section Chief (doc)
- Business Continutity Branch
- Haz Mat Branch
- Infrastructure Branch
- Building/Grounds Damage Unit Leader (doc)
- Environmental Services Unit Leader (doc)
- Food Services Unit Leader (doc)
- HVAC Unit Leader (doc)
- Infrastructure Branch Director (doc)
- Medical Devices Unit Leader (doc)
- Medical Gases Unit Leader (doc)
- Power Lighting Unit Leader (doc)
- Water Sewer Unit Leader (doc)
- Medical Care Branch
- Security Branch
- Annex H – Glossary (doc)
- Annex I – Acronyms (doc)
- Annex J – Forms
- Introduction (doc)
- Forms
- Decedent Tracking Form (doc)
- Fatality Count Tracking Form (doc)
- HICS 201 (doc)
- HICS 202 (doc)
- HICS 203 (doc)
- HICS 204 (doc)
- HICS 205 (doc)
- HICS 206 (doc)
- HICS 207 (doc)
- HICS 213 (doc)
- HICS 214 (doc)
- HICS 251 (doc)
- HICS 252 (doc)
- HICS 253 (doc)
- HICS 254 (doc)
- HICS 255 (doc)
- HICS 256 (doc)
- HICS 257 (doc)
- HICS 258 (doc)
- HICS 259 (doc)
- HICS 260 (doc)
- HICS 261 (doc)
- Kansas Notifiable Disease Form (pdf)
- Kansas SNS Request Form (doc)
- Mass Fatailty Incident Transportation Log (doc)
- Patient Belongings Inventory (doc)
- SNS Screening Form (doc)
- HICS Forms Instructions
- HICS 201 Instructions (doc)
- HICS 202 Instructions (doc)
- HICS 203 Instructions (doc)
- HICS 204 Instructions (doc)
- HICS 205 Instructions (doc)
- HICS 206 Instructions (doc)
- HICS 207 Instructions (doc)
- HICS 213 Instructions (doc)
- HICS 214 Instructions (doc)
- HICS 251 Instructions (doc)
- HICS 252 Instructions (doc)
- HICS 253 Instructions (doc)
- HICS 254 Instructions (doc)
- HICS 255 Instructions (doc)
- HICS 256 Instructions (doc)
- HICS 257 Instructions (doc)
- HICS 258 Instructions (doc)
- HICS 259 Instructions (doc)
- HICS 260 Instructions (doc)
- HICS 261 Instructions (doc)
- Annex K – References and Authorities (doc)
- Additional Planning Resources
- Kansas Hospital Association Resources
- Decontamination
- Other
- Guide to Hospital Emergency Operations (.pdf)
- Hospital Emergency Operations Plan Evaluation Tools
- Hospital Incident Command System (State of California)
Kansas System for Early Registration of Volunteers (K-SERV)
The purpose of these standard operating procedures (SOP) is to provide guidance for volunteer management. The SOPs are divided into several sections such as Request and Receipt of Local Volunteer Resources and the Management of Spontaneous Unaffiliated Volunteers. In addition, the SOPs are tailored for specific organizations and roles.
Local Public Health COOP SOG
The purpose of the COOP plan is to establish policy and guidance to ensure that essential functions for county health departments are continued in the event that manmade, natural, or technological emergencies disrupt or threaten to disrupt normal operations. The COOP plan enables the health department to operate with a significantly reduced workforce and diminished availability of resources, and to operate from an alternate work site should the primary facility become uninhabitable.
- Continuity of Operations SOG Guidance Document (.doc)
- Continuity of Operations SOG Template (.doc)
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Supporting Documents
- E-1 – Redundant Communications (xls)
- E-2 – Communications Flowchart (doc)
- Q-1 – Activation Scenarios & Decision-Making Matrix (doc)
- Q-2 – Alternate Work Site
- Q-3 – Essential Functions (xls)
- Q-4 – Delegations of Authority (xls)
- Q-5 – Vital Records & Databases (xls)
- Q-6 – Vital Systems & Equipment (xls)
- Q-7 – Drive Away Kit Inventory (xls)
- Q-8 – Glossary of Terms (doc)
- Q-9 – Checklist
- Q-10 – Devolution (doc)
- Q-11 – Evacuation Plan (doc)
- Q-12 – Rapid Recall List (xls)
- Q-13 – Reconstitution Team (xls)
- T-1 – Training, Exercise & Evaluation (doc)
- T-2 – Training, Exercise & Evaluation Log (xls)
Mass Dispensing SOG
This standard operating guide (SOG) may be used during an emergency for management of medical materials from the state including Strategic National Stockpile (SNS) assets. This template contains all information necessary for medical materials management, including point-of-contact information, clinic maps, flow charts, and point-of-dispensing (POD) clinic management guidance.
- Mass Prophylaxis Dispensing Standard Operating Guide (.doc)
Demobilization Language
Inventory Management System Language - Supporting Documents
- Annex A – Introduction, Reference Documents
- Annex B – Levels of Activation (doc)
- Annex C – Command and Control
- C-1 – Public Health Incident Command
- C-2 – Incident Action Plan Forms
- ICS 201 Incident Briefing (doc)
- ICS 202 Incident Objectives (doc)
- ICS 203 Organization Assignment List (doc)
- ICS 204 Division Assignment Log (doc)
- ICS 205 Incident Radio Communications Plan (doc)
- ICS 205A Incident Radio Inventory Log (doc)
- ICS 206 Medical Plan (doc)
- ICS 209 Incident Status Summary (doc)
- ICS 211 Incident Check In (doc)
- ICS 213 General Message (doc)
- ICS 214 Unit Activity Log (doc)
- ICS 215 Operational Planning Worksheet (doc)
- ICS 215A Incident Safety Analysis (doc)
- ICS 216 Radio Requirements Worksheet (doc)
- ICS 218 Support Vehicle Inventory (doc)
- ICS 230 Daily Meeting Schedule (doc)
- C-3 – Command Staff Job Action Sheets (doc)
- Annex D – Emergency Phone Book and Notification
- Annex E – Communication Systems
- Annex G – Local and Regional Resources
- Annex H – Requesting State Resources
- Annex I – Medical Material Management, Storage and Handling
- I-1 – Controlled Substances
- I-2 – Standing Orders
- Sample Standing Order General (doc)
- Sample Standing Orders Influenza (doc)
- Sample Tamiflu Form (doc)
- I-3 – Storage & Handling
- Annex J – Medical Material Receipt and Transport Operations
- Annex K – Local Distribution Site Planning
- Annex L – Priority Prophylaxis (doc)
- Annex M – POD Operations
- M-1 – County Statistics
- M-2 – Clinic Supplies
- Signage
- LCHD Signs 1-10 (ppt)
- LCHD Signs 11-20 (ppt)
- LCHD Signs 21-30 (ppt)
- Medication Center–Green (pdf)
- Emergency Drill (pdf)
- Medication Center–Blue (pdf)
- Thank You (pdf)
- Prohibited (pdf)
- Privacy (pdf)
- Anthrax–Orange (pdf)
- Botulism–Orange (pdf)
- Hemorrhagic Fever–Orange (pdf)
- Plague–Orange (pdf)
- Smallpox–Orange (pdf)
- Tularemia–Orange (pdf)
- Vest (pdf)
- Entrance (pdf)
- Four Steps (pdf)
- Anthrax–Green (pdf)
- Botulism–Green (pdf)
- Hemorrhagic Fever–Green (pdf)
- Plague–Green (pdf)
- Smallpox–Green (pdf)
- Tularemia–Green (pdf)
- Step 1–Portrait (pdf)
- Step 1–Landscape (pdf)
- Step 2–Portrait (pdf)
- Step 2–Landscape (pdf)
- Help Line (pdf)
- Family Line (pdf)
- Adult Line (pdf)
- Please Wait (pdf)
- Step 3–Portrait (pdf)
- Step 3–Landscape (pdf)
- Step 4–Portrait (pdf)
- Step 4–Landscape (pdf)
- Thank You–2 (pdf)
- Medical Evaluation (pdf)
- Ambulance (pdf)
- First Aid (pdf)
- Exit (pdf)
- No Exit (pdf)
- Incident Command (pdf)
- Break Room (pdf)
- No Entrance (pdf)
- Arrow (pdf)
- Sign Hearing (pdf)
- Sign Language (pdf)
- Chinese Interpreter (pdf)
- Japanese Interpreter (pdf)
- Korean Interpreter (pdf)
- Russian Interpreter (pdf)
- Spanish Interpreter (pdf)
- Tagalog Interpreter (pdf)
- Vietnamese Interpreter (pdf)
- Basic Toolkit (pdf)
- Center Layout (pdf)
- Clinic Supplies (xls)
- Signage Sample Recommendations (pdf)
- Suggested Flu Clinic Supplies (doc)
- Signage
- M-3 – Internal Maps
- M-4 – External Flow Map Sample (ppt)
- M-5 – CDC Influenza Anthrax Plague Tularemia (pdf)
- M-6 – POD Clinic Forms
- Screening Forms
- Immunization Screening Adult (pdf)
- Immunization Screening Adult Spanish (pdf)
- Immunization Screening Child & Teen (pdf)
- Immunization Screening Child & Teen Spanish (pdf)
- Screening Injectable Influenza Vaccination (pdf)
- Screening Injectable Influenza Vaccination Spanish (pdf)
- Screening Intranasal Influenza Vaccine (pdf)
- Screening Intranasal Influenza Vaccine Spanish (pdf)
- Employee Shift Schedule (xls)
- ICS 213 Clinic Emergency Incident Message Form (doc)
- ICS 211 Incident Check In for Staff & Volunteers (doc)
- ICS 213 General Message Form (doc)
- ICS 214 Unit Activity Log Form (doc)
- Incident Report Form (doc)
- Procurement Summary Report (doc)
- Resource Request Form (doc)
- Worker Emergency Contact Form (doc)
- Screening Forms
- M-8 – Medical Preparation
- M-9 – POD Security Assessment (doc)
- M-10 – Language Line Information Sheet (doc)
- M-11 – POD Job Action Sheets (doc)
- M-12 – JIT Training
- M-13 – Other Material
- Berm Model
- Annex N – Alternate Dispensing Plans (doc)
- Annex O – Treatment Center Coordination (doc)
- Annex P – MOU's
- Annex List (doc)
- Annex Title Pages (doc)
- Additional Planning Resources
- Mass Prophylaxis Dispensing Preplanning Tool (.doc)
- Technical Assistance Guidance For Local Strategic National Stockpile Planners, Version 4.1 (.doc)
- Bioterrorism and Epidemic Outbreak Response Model (BERM) Version 2 (.xls)
- Introduction to the Strategic National Stockpile (.pdf)
- Local Distribution Site Survey (.doc)
- Local Technical Assistance Review Tool (.doc)
- Automated Technical Assistance Review Score Sheets (.xls)
- Mass Prophylaxis/Vaccination Campaign Staffing Model (.xls)
- Name, Address, Phone, Health History (NAPH) Form (.pdf)
- Name, Address, Phone, Health History (NAPH) Form en Español (.pdf)
- PharmFinder tutorial (.doc)
- POD Assessment Tool (.pdf)
- POD Security Assessment Form (.doc)
- POD Site MOA (.doc)
- SNS Planning Guidance, Version 10.02 (.pdf)
- Sample County Commission Letter (.doc)
- Sample SNS Wording for Local Biological Incident Annex (.doc)
- Using the Version 10.02 Revision Table (.pdf)
Public Information & Communication SOG
The Public Information & Communication Standard Operating Guide (PIC-SOG) provides step-by-step instructions, tools and templates for planning public information and communication activities to support Mass Dispensing operations consistent with the CDC Strategic National Stockpile Technical Assistance Review (SNS-TAR), as well as all-hazards public information preparedness and response activities.
- Public Information & Communication SOG Template (.doc)
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Supporting Documents
- Annex A – Reference Documents
- Annex C – Command and Control
- Annex D – Emergency Phonebook and Notification
- Annex E – Communication Systems
- Annex F – Public Information
- Annex F1 – Health Education Materials
- Biological Hazards
- Anthrax Factsheet (.doc)
- Anthrax Factsheets, non-English
- Anthrax Factsheet, Arabic (.pdf)
- Anthrax Factsheet, Burmese (.pdf)
- Anthrax Factsheet, Chinese, Simplified (.pdf)
- Anthrax Factsheet, German (.pdf)
- Anthrax Factsheet, Spanish (.pdf)
- Anthrax Factsheet, Farsi (.pdf)
- Anthrax Factsheet, French (.pdf)
- Anthrax Factsheet, Hmong (.pdf)
- Anthrax Factsheet, Cambodian (.pdf)
- Anthrax Factsheet, Korean (.pdf)
- Anthrax Factsheet, Nepali (.pdf)
- Anthrax Factsheet, Somali (.pdf)
- Anthrax Factsheet, Thai (.pdf)
- Anthrax Factsheet, Vietnamese (.pdf)
- Botulism Factsheet (.doc)
- Botulism Factsheets, non-English
- Botulism Factsheet, Arabic (.pdf)
- Botulism Factsheet, Burmese (.pdf)
- Botulism Factsheet, Chinese, Simplified (.pdf)
- Botulism Factsheet, German (.pdf)
- Botulism Factsheet, Spanish (.pdf)
- Botulism Factsheet, Farsi (.pdf)
- Botulism Factsheet, French (.pdf)
- Botulism Factsheet, Hmong (.pdf)
- Botulism Factsheet, Cambodian (.pdf)
- Botulism Factsheet, Korean (.pdf)
- Botulism Factsheet, Nepali (.pdf)
- Botulism Factsheet, Somali (.pdf)
- Botulism Factsheet, Thai (.pdf)
- Botulism Factsheet, Vietnamese (.pdf)
- Plague Factsheet (.doc)
- Plague Factsheets, non-English
- Plague Factsheet, Arabic (.pdf)
- Plague Factsheet, Burmese (.pdf)
- Plague Factsheet, Chinese, Simplified (.pdf)
- Plague Factsheet, German (.pdf)
- Plague Factsheet, Spanish (.pdf)
- Plague Factsheet, Farsi (.pdf)
- Plague Factsheet, French (.pdf)
- Plague Factsheet, Hmong (.pdf)
- Plague Factsheet, Cambodian (.pdf)
- Plague Factsheet, Korean (.pdf)
- Plague Factsheet, Nepali (.pdf)
- Plague Factsheet, Somali (.pdf)
- Plague Factsheet, Thai (.pdf)
- Plague Factsheet, Vietnamese (.pdf)
- Ricin Factsheet (.doc)
- Ricin Factsheets, non-English
- Ricin Factsheet, Arabic (.pdf)
- Ricin Factsheet, Burmese (.pdf)
- Ricin Factsheet, Chinese, Simplified (.pdf)
- Ricin Factsheet, German (.pdf)
- Ricin Factsheet, Spanish (.pdf)
- Ricin Factsheet, Farsi (.pdf)
- Ricin Factsheet, French (.pdf)
- Ricin Factsheet, Hmong (.pdf)
- Ricin Factsheet, Cambodian (.pdf)
- Ricin Factsheet, Korean (.pdf)
- Ricin Factsheet, Nepali (.pdf)
- Ricin Factsheet, Somali (.pdf)
- Ricin Factsheet, Thai (.pdf)
- Ricin Factsheet, Vietnamese (.pdf)
- Smallpox Factsheet (.doc)
- Smallpox Factsheets, non-English
- Smallpox Factsheet, Arabic (.pdf)
- Smallpox Factsheet, Burmese (.pdf)
- Smallpox Factsheet, Chinese, Simplified (.pdf)
- Smallpox Factsheet, German (.pdf)
- Smallpox Factsheet, Spanish (.pdf)
- Smallpox Factsheet, Farsi (.pdf)
- Smallpox Factsheet, French (.pdf)
- Smallpox Factsheet, Hmong (.pdf)
- Smallpox Factsheet, Cambodian (.pdf)
- Smallpox Factsheet, Korean (.pdf)
- Smallpox Factsheet, Nepali (.pdf)
- Smallpox Factsheet, Somali (.pdf)
- Smallpox Factsheet, Thai (.pdf)
- Smallpox Factsheet, Vietnamese (.pdf)
- Tularemia Factsheet (.doc)
- Tularemia Factsheets, non-English
- Tularemia Factsheet, Arabic (.pdf)
- Tularemia Factsheet, Burmese (.pdf)
- Tularemia Factsheet, Chinese, Simplified (.pdf)
- Tularemia Factsheet, German (.pdf)
- Tularemia Factsheet, Spanish (.pdf)
- Tularemia Factsheet, Farsi (.pdf)
- Tularemia Factsheet, French (.pdf)
- Tularemia Factsheet, Hmong (.pdf)
- Tularemia Factsheet, Cambodian (.pdf)
- Tularemia Factsheet, Korean (.pdf)
- Tularemia Factsheet, Nepali (.pdf)
- Tularemia Factsheet, Somali (.pdf)
- Tularemia Factsheet, Thai (.pdf)
- Tularemia Factsheet, Vietnamese (.pdf)
- Viral Hemorrhagic Fever Factsheet (.doc)
- Viral Hemorrhagic Fever Factsheets, non-English
- Viral Hemorrhagic Fever Factsheet, Arabic (.pdf)
- Viral Hemorrhagic Fever Factsheet, Burmese (.pdf)
- Viral Hemorrhagic Fever Factsheet, Chinese, Simplified (.pdf)
- Viral Hemorrhagic Fever Factsheet, German (.pdf)
- Viral Hemorrhagic Fever Factsheet, Spanish (.pdf)
- Viral Hemorrhagic Fever Factsheet, Farsi (.pdf)
- Viral Hemorrhagic Fever Factsheet, French (.pdf)
- Viral Hemorrhagic Fever Factsheet, Hmong (.pdf)
- Viral Hemorrhagic Fever Factsheet, Cambodian (.pdf)
- Viral Hemorrhagic Fever Factsheet, Korean (.pdf)
- Viral Hemorrhagic Fever Factsheet, Nepali (.pdf)
- Viral Hemorrhagic Fever Factsheet, Somali (.pdf)
- Viral Hemorrhagic Fever Factsheet, Thai (.pdf)
- Viral Hemorrhagic Fever Factsheet, Vietnamese (.pdf)
- Chemical Hazards
- Natural Disasters
- Nuclear Hazards
- Radiological Hazards
- Biological Hazards
- Annex F2 – Phone Bank
- Annex F3 – Mass Dispensing
- Mass Dispensing Campaign
- Mass Dispensing Message Maps
- Mass Dispensing News Release Templates
- Instructions to Public Based Upon Symptoms (.doc)
- Mass Dispensing – Clinic Opening (Direct to Site) (.doc)
- Mass Dispensing – Clinic Procedures (Navigate Site) (.doc)
- Mass Dispensing – Clinic Update (Direct to Site) (.doc)
- Mass Dispensing – Clinic Volunteer Request (.doc)
- Mass Dispensing – After the POD (After Leaving) (.doc)
- Mass Dispensing – Medication Compliance (.doc)
- Mass Dispensing – Clinic Closure (.doc)
- Point of Dispensing (POD) Pictograms
- Annex F4 – 77 Questions Commonly Asked by Journalists During a Crisis (.doc)
- Annex F1 – Health Education Materials
Safety Net Clinics Emergency Management Plan
KDHE and the Kansas Association for the Medically Underserved developed a comprehensive emergency management plan template to assist safety net clinics with preparing for and responding to disasters affecting clinics and communities. To effectively prepare for an emergency, each clinic should have an emergency preparedness and response plan that is adopted by the board of directors, shared and understood by all staff and connected to plans with community partners.
- Emergency Management Plan Template Guidance (.doc)
- Emergency Management Plan Template (.doc)
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Supporting Documents
- Annex A – Clinic ICS
- Annex B – Position Checklists
- Communications Unit Leader (.doc)
- Compensation/Claims Unit Leader (.doc)
- Cost Unit Leader (.doc)
- Demobilization Unit Leader (.doc)
- Division/Group Supervisor (.doc)
- Documentation Unit Leader (.doc)
- Facilities Unit Leader (.doc)
- Finance/Administration Section Chief (.doc)
- Food Unit Leader (.doc)
- Incident Commander (.doc)
- Liaison Officer (.doc)
- Logistics Section Chief (.doc)
- Medical Unit Leader (.doc)
- Operations Branch Director (.doc)
- Operations Section Chief (.doc)
- Planning Section Chief (.doc)
- Procurement Unit Leader (.doc)
- Public Information Officer (.doc)
- Resources Unit Leader (.doc)
- Safety Officer (.doc)
- Service Branch Director (.doc)
- Situation Unit Leader (.doc)
- Staging Area Manager (.doc)
- Strike Team/Task Force Leader (.doc)
- Supply Unit Leader (.doc)
- Support Branch Director (.doc)
- Time Unit Leader (.doc)
- Annex C – Incident Management Forms
- ICS Forms Review (.doc)
- ICS 201 – Incident Briefing (.doc)
- ICS 202 – Incident Objectives (.doc)
- ICS 203 – Organizational Assignment List (.doc)
- ICS 204 – Field Assignment (.doc)
- ICSS 205 – Incident Communications Plan (.doc)
- ICS 206 – Medical Plan (.doc)
- ICS 207 – Organizational Chart (.doc)
- ICS 209 – Incident Status Summary (.doc)
- ICS 211 – Check-In/Out List (.doc)
- ICS 213 – General Message (.doc)
- ICS 214 – Unit Log (.doc)
- ICS 215 – Operational Planning Worksheet (.doc)
- ICS 215A – Incident Action Plan Safety Analysis (.doc)
- ICS 221 – Demobilization Plan and Check Out (.doc)
- ICS 308 – Resource Order Form (.pdf)
- Facilities System Status Report (.doc)
- Personnel Time Sheet (.doc)
- Volunteer Registration (.doc)
- Kansas Notifiable Disease Form (.pdf)
- Kansas Notifiable Disease Form – Labs (.pdf)
- Annex D – Directories
- Plan Maintenance Schedule (.xls)
- Plan Maintenance Schedule (.doc)
- Resource Directory (.xls)
- Resource Directory (.doc)
- Staff and Volunteer Directory (.xls)
- Staff Directory (.doc)
- Volunteer Directory (.doc)
- Annex E – Planning and Storage Requirements
- Annex F – Glossary (doc)
- Additional Planning Resources
How to Submit a Plan as a Grant Deliverable
Preparedness is obligated to retain copies of certain SOGs under the terms various federal grants. Sub-grantees of the local public health emergency preparedness grant and hospital preparedness grant should submit completed local agency plans associated with their grant deliverables to Preparedness either electronically (preferred) or by mail to:
Kansas Department of Health and Environment
Bureau of Community Health Systems
1000 SW Jackson Ste 340
Topeka, KS 66612
btgrantreports@kdheks.gov
Preparedness recommends that agencies print off their completed plans, SOGs and other documents and assemble them into notebooks.
How to Request Technical Assistance for Planning
What is technical assistance?
Technical assistance can be provided to health and medical agencies to help orient them on specific planning topics. If you are a new planner or looking for additional ideas on enhancing plans, KDHE can provide assistance to educate the agencies through one on one or group discussions. Assistance can be requested by contacting your respective KDHE jurisdictional planner. Type of assistance that can be provided include Technical Assistance Review (TAR) guidance, Standard Operating Procedure (SOP)/Standard Operating Guide (SOG) review, Standard Operating Procedure (SOP)/Standard Operating Guide (SOG) training and general planning questions.
Field Technical Assistance Team Map (.pdf) Updated July 8, 2011
Planning Development & Review Team Map (.pdf) Updated July 8, 2011
