Mass Casualty Decon Safety Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

ADVON

• Date and time of command element briefing

  Date

• General site briefing comppleted

  Yes

  No

  N/A

• LNO identified and staffed with local command element

  Yes

  No

  N/A

• Unit Commander, Command Staff, Unit Safety Officer, and NCOIC: are present at site briefing.

  Yes

  No

  N/A

• Companies are briefed that they are working in a crime zone.

  Yes

  No

  N/A

• ADVON given permission with PMT to advance and occupy incident site

  Yes

  No

  N/A

• Level I, II, and III evacuation protocols are explained and briefed.

  Yes

  No

  N/A

• Date and time ADVON & PMT launched

  Date

Site Occupation

• Is there sufficient room for the operational footprint?

  Yes

  No

  N/A

• Current wind direction.

  Safe

  At Risk

  N/A

• Terrain slope is level or negative toward the hot zone.

  Yes

  No

  N/A

• Hazard material is classified, provide details of material classification / identification.

  Yes

  No

  N/A

• PMT results are within acceptable exposure limits for site setup

  Yes

  No

  N/A

• Preliminary site tasking is completed

  Yes

  No

  N/A

• Request permission for main body movement to site.

  Yes

  No

  N/A

• Main body granted permission to move up and occupy site at:

  Date

Main Body on Site

• Main Body on site at:

  Date

• Initial safety briefing done with NCOICs and all ground personnel?

  Yes

  No

  N/A

• Briefed on known or suspected hazard, including RoE, S&S, Decon efficacy.

  Yes

  No

  N/A

• Briefed on loading, carrying, lifting, pinch points, and slip / trip, fall hazards.

  Yes

  No

  N/A

• Briefed electrical hazards, grounding, GFCI, and cord management.

  Yes

  No

  N/A

• Briefed on hydration, work periods and general operations.

  Yes

  No

  N/A

• Briefed on level I, II, and III evacuation contingencies.

  Yes

  No

  N/A

• Identified any alarm / alert LoC ( levels of concern) that must be reported.

  Yes

  No

  N/A

• Identified setup footprint and direction of travel.

  Yes

  No

  N/A

• Initiated site setup start time.

  Date

MCD setup preliminary walk down.

• Identified any potential site hazards and corrected / adjusted. (terrain, debris, litter, potential evidence, etc.)

  Yes

  No

  N/A

• Generators at safe distance and grounded

  Yes

  No

  N/A

• Flash heaters at safe distance and location.

  Yes

  No

  N/A

• Blivets at appropriate distance and location.

  Yes

  No

  N/A

• Fire extinguishers located near all potential fire hazards.

  Yes

  No

  N/A

• Tent guy lines marked and anchored correctly.

  Yes

  No

  N/A

• Litter rollers locked and secured.

  Yes

  No

  N/A

• Patient litters in correct location and repair.

  Yes

  No

  N/A

• Detection devices prepped, bump tested and LoC posted in monitoring areas.

  Yes

  No

  N/A

• CCP located to reduce ancillary traffic between tents.

  Yes

  No

  N/A

• Med-Ops briefed on potential products and treatment.

  Yes

  No

  N/A

• Electrical and water line management is appropriate.

  Yes

  No

  N/A

• Electrical connections and load are correct for safe usage.

  Yes

  No

  N/A

• Operations are conducted to secure and identify personal belongings and patient effects. (crime scene)

  Yes

  No

  N/A

• Patient ID and disposition is identified.

  Yes

  No

  N/A

• Final safety walk and permission to go hot communicated to command at;

  Date

TTP Operational Checks

• All line personnel briefed and functioning under direction of respective NCOICs.

  Yes

  No

  N/A

• All medical treatment follows START and combat lifesaver TTP.

  Yes

  No

  N/A

• Any lane problems are reported to unit and command safety personnel.

  Yes

  No

  N/A