Mendocino County Office of Education  Situation Report
                                                          INSTRUCTIONS REPORT TYPE
Both the sending party and the receiving party must have copies of this form. 
Reporting may be by voice or amateur (ham) radio digital means.
FAX this completed report to MCOE at (707) 462-0379 		Inital
Update #  
Final
1 Incident Name       2a. Date     2b. Time    
3a. Facility Name     3b. Facility Type :  District  School  Other 
4a. Contact Name    4b. Contact Phone     Ext.  
4c. Contact Cell Phone     4d. Contact email Address   
STATUS REPORTING CODES
A = NORMAL
Fully Functional  		 B = MODIFIED  
Partially Functional  
No assistance needed  		C = LIMITED  
Partially Functional  
Some Assistance 
needed (Explain)
 D = IMPAIRED  
Major assistance  
needed (Explain)		 E = NOT FUNCTIONAL  
Major assistance  
needed (Explain)		 F = UNKNOWN
COMMENTS If not fully functional, give location, reason, estimated time or resources needed for repair or other information. Send an ICS 213 follow up report if necessary.
5. FACILITY OPERATING STATUS      If reporting by voice, speak only the item number and a single status letter
5.1   Summary Status  ________________________ A   B   C   D   E   F  
6. COMMUNICATIONS If reporting by voice, speak only the item number and a single status letter
6.1    Email _________________________________
 A   B   C   D   E   F  
6.2    Landline Phone _________________________
 A   B   C   D   E   F  
6.3    Fax ___________________________________
 A   B   C   D   E   F  
6.4    Internet ____________________________
 A   B   C   D   E   F  
6.5    Cell Phone _____________________________
 A   B   C   D   E   F  
6.6    Satellite Phone __________________________
 A   C   B   D   E   F  
6.7    School Bus Radio ___________________
 A   B   C   D   E   F  
6.8    Ham Radio _____________________________
 A   B   C   D   E   F  
7. UTILITIES If reporting by voice, speak only the item number and a single status letter
7.1    Power _________________________________
 A   B   C   D   E   F  
7.2    Water _________________________________
 A   B   C   D   E   F  
7.3    Sanitation ______________________________
 A   B   C   D   E   F 
7.4    Heating/Ventilation/AC ___________________
 A   B   C   D   E   F  
8. EVACUATION If reporting by voice, speak only the item number and Yes or No and the status single word if Yes
8.1    Evacuating? ____________________________
 YES  NO   If yes,    Anticipated  In progress  Completed    
8.2    Partial Evacuation? ______________________
 YES  NO    If yes,   Anticipated  In progress  Completed    
8.3    Total Evacuation? _______________________
 YES  NO    If yes,   Anticipated  In progress  Completed    
8.4    Shelter in Place? ________________________
 YES  NO    If yes,   Anticipated  In progress  Completed    
9. IMPACT / CASUALITIES  If reporting by voice, speak only the item number and the number of estimated casualities
9.1    Immediate injuries = Critical care needed Estimated #
9.2    Delayed injuries = Moderate care needed Estimated #
9.3    Minor injuries = Care not needed immediately Estimated #
9.4    Fatalities Estimated #
10. ADDITIONAL INFORMATION If reporting by voice, speak only the item number and Yes or No
10.1    Is internal disaster plan activated?   YES     NO
10.2    Is Facility Command Center activated?   YES     NO
10.3    Is Emergency generator power in use?   YES     NO
10.4    Will you send Resource Request within 4 hours?   YES     NO