California Standardized Emergency Management System
                       Hazardous Materials Unit Status Report

Operational Area:  

From City:

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: 

EMS                     |a. Status |b. Remarks
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7. Estimated Casualties |          |
                        |          |
a. Deaths:              |          |
                        |          |
b. Major Injuries:      |          |
                        |          |
c. Minor Injuries:      |          |
                        |          |
d. Missing:             |          |
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HAZMAT RESPONSE       |a. Agency  | b. Remarks(including incident name)
                      |    Name   | 
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8. Agency Responding  |           |
                      |           |
9. Response Needed:   |(Yes/No)   |   
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10. Critical Issues:      
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11. Prognosis:        |(Nochange/ |
                      |Worsening/ |
                      |Improving) |   
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12. Point Of Contact

a. Name:                               b. Phone:

c. Fax Number:                         d. Alt Phone:

Created by:                          on: (date/time)

Last Modified by:                    on: (date/time)