California Standardized Emergency Management System Care & Shelter Branch Status Report Operational Area: Region: Law Mutual Aid Region: Fire Mutual Aid Region: 1. Event Name: 2. Event Date: 3. Overall Status: (Red/Black/Yellow/ 4. As Of: (date/time) Green) 5. Areas Affected: 6. Situation: 7.Number of shelters open: a. Status: (Red/ b. Remarks Black/Yellow/ Green) |a. Status |b. Remarks | | 8. # of persons displaced: | | | | 9. # of persons in shelters: | | | | 10. # of persons not sheltered:| | | | 11. # of fixed feeding sites: | | | | 12. # of mobile feeding sites: | | | | 13. # of persons fed in past | | 24 hours: | | | | 14. # of persons projected to | | be fed in next 24 hours: | | | | 15. Mutual aid received in last| | 24 hours: |(Yes/No) | | | 16. Mutual aid needed in next | | 24 hours: |(Yes/No) | | | 17. Critical Issues: |(Yes/No) | | | 18. Prognosis: |(No Change/| |Worsening/ | |Improving) | 19. Point Of Contact a. Name: b. Phone: c. Fax Number: d. Alt Phone: 20.a. Shelter Locations: (Optional information) a. Name b. Address ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ 20.b. Shelter Locations- Continued: (Optional information) a. Name b. Address 20.c. Shelter Locations- Continued: (Optional information) a. Name b. Address ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ 20.d. Shelter Locations- Continued: (Optional information) a. Name b. Address ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Name: Street: POC: City/Zip: Phone: ------------------------------------------------------------------------------ Completed by: on: (date/time) Last Modified by: on: (date/time)