NZ-USAR - Worksite Report Form

• Report Number No.

• Assignment Complete

  Yes

  No

  N/A

• Worksite Title [Identifying descriptor]

• E1: Worksite ID:

• Conducted on

  Date

• Prepared by:

• Location
  Address

• G1: Assigned Team ID

E: Worksite Details

• E1: worksite ID

• E2/E3: GPS/Address
  Address

• E4: Worksite Boundary Description

G: Worksite Situation Report

• G2/G3: Start Date & Time of reporting period

  Date

• G4: ASR Level

  ASR 3

  ASR 4

  ASR 5

• G5: ASR Level Status

  In Progress

  Complete

• G12: Live Rescues completed

• G13 Dead Persons removed

• G15: Safety/Security Issues

• G16: Other Activities on site

• G17: Resources able to be released from site

• G18 Operationally relevant local onsite contacts

• G19/G20: End date & Time of Reporting period

  Date

• G1: Assigned Team(s) ID

G: Worksite Planning

• G6: Estimated date level completion

  Date

• G7: Estimated time level completion

  Date

• G10: Total Missing Persons

• G11: Confirmed Live Contacts

• G14: Logistical needs

H: Annex

• H1: Previous worksite reports [File names]

• H2: Sketch of worksite

  Drawing

• H3: Victim Extraction forms (F5) [File names]

• H4: Pictures included [File names]

  Media

I: Additional Information

• Information

Z: Form sign off/completed by

• Z1: Name

• Z2: Title/Position

  Yes

  No

  N/A

• Signature

  Sign

• Sign off date/Time

  Date