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MSDC Incident Liaison Officer Report V1.0
MSDC Incident Liaison Officer Report V1.0
Ben Toogood

MSDC Incident Liaison Officer Report V1.0 Checklist

MSDC ILO Major Incident Report Form v1.0

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Free MSDC Incident Liaison Officer Report V1.0 Checklist

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ILO Details

ILO Name:

ILO Mobile Number:

Activation
Time ILO was notified of Incident

MSDC Assistance Requested?

Please specify:

ILO attendance required?

ETA:
Actual time of Arrival:

MSDC RAG Status at this time

Further Notification

MSDC Officer(s) notified (as per Emergency Plan):

ECC required?

Location

Incident Details (METHANE)
Date and Time of Incident:

Has a Major Incident been declared?

Which organisation declared it?
  • Police
  • Fire
  • Ambulance
  • SRF
  • Local Authority
  • NHS
  • Central Government

Name of officer (if known):

Exact location of Incident:
Type of incident
  • Fire
  • Chemical Spill
  • Gas Leak
  • Building collapse
  • Weather Related
  • Live Ordinance
  • Public Order
  • Security/Terror Related
  • Transport Accident
  • Other

Please specify

Hazards:

Access routes:

Are local roads closed?

Please provide details:

Number, type and severity of Casualties:

Emergency Services Present

Police:

Fire:

Ambulance:

Others required?

Please specify:

Photo of incident site
Safety:

Initial Risk Assessment Undertaken by ILO:

ILO situated in a place of safety

ILO to remain outside the Outer Cordon:

Incident Command
Time ILO reported to Incident Command/Control Point

Fire Commander Name & Number:

Police Commander Name & Number:

Ambulance Commander Name & Number:

Other partners present?

Add details here:

Silver briefing called?

Time of first Silver Briefing:

Notes:

Local Authority Assistance Required

Building Control Requested?

BCO Present?

BCO Time of arrival

Rest Centre Required?

Please specify type:
  • Rest Centre (for Evacuees)
  • Survivor Reception Centre
  • Friends & Family Reception Centre
  • Humanitarian Assistance Centre
Rest Centre Capacity Required:

Suggest Nearest Pavilion or Small Hall

Suggest Local Village/Town Hall

Suggest Large Rest Centre (MSDC Leisure Centre or Hall)

More than one large rest centre may be required. (Consider mutual aid)

Recommended Rest Centre(s):

Staff informed:

Volunteer Agencies Informed:

Time required by:
SRC Capacity Required:

Suggest Nearest Pavilion or Small Hall

Suggest Local Village/Town Hall

Suggest Large Rest Centre (MSDC Leisure Centre or Hall)

More than one large rest centre may be required. (Consider mutual aid)

Recommended SRC:

Staff informed:

Police aware of their requirement to manage the SRC

Volunteer Agencies Informed:

Time required by:
Capacity Required for FFRC:

Suggest Nearest Pavilion or Small Hall

Suggest Local Village/Town Hall

Suggest Large Rest Centre (MSDC Leisure Centre or Hall)

More than one large rest centre may be required. (Consider mutual aid)

Recommended FFRC:

Staff informed:

Volunteer Agencies Informed:

Time required by:
Capacity Required for HAC:

Suggest Nearest Pavilion or Small Hall

Suggest Local Village/Town Hall

Suggest Large Rest Centre (MSDC Leisure Centre or Hall)

More than one large rest centre may be required. (Consider mutual aid)

Recommended HAC:

Staff informed:

WSCC Informed:

Volunteer Agencies Informed:

Time required by:

Transport required?

Who is arranging?
  • County Council
  • British Red Cross
  • Other Volunteers
  • MSDC

MSDC Media Officer required?

Name of media officer attending:

Has SCG Meeting been called?

Name the MSDC officer to attend:

Date and Time of first SCG Meeting:

Where will SCG convene?

Preparing for Recovery

Has RCG Meeting been called?

Name the MSDC officer to attend:

Date and Time of first RCG Meeting:

Where will RCG convene?

Will MSDC be required to clear waste from the incident site?

List the services required:
  • Waste Contractor
  • Demolition Contractor
  • Landscape Contractor
  • Salvage Contractor
  • Environmental Health
  • Cleaning Contractor

Will additional MSDC resources be required to support the community during recovery?

Please provide details:

Incident Log (of any additional actions taken by ILO which were not previously noted)
Date/Time this log commenced

Incident Log

Log Entry
Date/time of this entry

Details

Date/Time this report completed and sent
Incident Liaison Officer Signature:
Date/Time of handover to another Incident Liaison Officer:
MSDC Incident Liaison Officer Report V1.0
Ben Toogood

MSDC Incident Liaison Officer Report V1.0

MSDC ILO Major Incident Report Form v1.0

Use this Digital Checklist
Download as PDF
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.

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