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2011-2012_Community_Hospital_Work_Plan

By Ashley Hart,2014-10-28 12:27
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2011-2012_Community_Hospital_Work_Plan

2011-2012 Kansas Hospital Preparedness Program

    Community Hospital Work Plan / Progress Report

Hospital Name

    Address, City, Zip

    Contact Person

    Contact Email Contact Phone

    Reporting Period Date Submitted

Progress Reports are to be submitted to Jeanie Clerico at jclerico@kha-net.org.

    Progress reports are to be completed four times during the grant year.

     Period 1 covers July through September and is due October 14, 2011.

     Period 2 covers October through December and is due January 16, 2012.

     Period 3 covers January through March and is due April 16, 2012.

     Period 4 covers April through June and is due July 16, 2012.

    PLEASE REFER TO THE FY2011 COMMUNITY HOSPITAL PREPAREDNESS PROGRAM GRANT

    GUIDANCE FOR SPECIFIC INFORMATION ON THE WORK PLAN TASKS.

    TASK Date Submitted

    #1 Continue to identify appropriate hospital personnel for training and be able to show verified

    completion of ICS 100, ICS 200, IS 700, and IS 800B or their equivalents by completing the NIMS Compliant Tool and submitting to KHERF for distribution. Tool must be submitted by February 1,

    2012. Tool can be found at www.ksprepared.org or www.kha-net.org.

    Completed

    Year-End Survey

    Yes or No

    #2 Continue to meet full incorporation and complete achievement of all 14 NIMS Elements by

    June 30, 2012 and verify compliance by completing a year-end survey. A copy of the NIMS

    Compliance elements can be found at www.ksprepared.org or www.kha-net.org.

    Page 1 of 3

    2011-2012 Kansas Hospital Preparedness Program Community Hospital Work Plan / Progress Report

    TASK Date Submitted #3 Complete an inventory of Hospital Preparedness Program resources by June 1, 2012.

    #4 Review and update their Hazard Vulnerability Assessment (HVA) and associated Gap Analysis (GA) to support Level 2 Sub-capability purchases. A copy of the HVA can be found at www.ksprepared.org. HVA and GA are to be submitted to KHERF no

    later than October 15, 2011.

    #5 Upload their Hazard Vulnerability Assessment and associated Gap Analysis into the organization’s H-ICS Library no later than December 31, 2011.

    #6 Upload their Emergency Operations Plan (EOP) and Annexes into the organization’s H-ICS Library no later than December 31, 2011.

    #7 Complete a comprehensive self-assessment review of their EOP and Annexes using the Hospital EOP Review Tool in coordination with their Regional Coordinator. The completed Self-Assessment Tool must be submitted to KHERF no later than

    February 29, 2012.

    Date(s) Date(s) Date(s) Date(s)

    Participate in collaborative multi-agency Participated Participated Participated Participated

    planning processes by: During Period 1 During Period 2 During Period 3 During Period 4 #8 Attending Regional Hospital Meetings. #9 Attending LEPC meetings, to the extent possible.

    Page 2 of 3

    2011-2012 Kansas Hospital Preparedness Program Community Hospital Work Plan / Progress Report

    TASK Name of Person(s) Date(s) Completed #10 A minimum of three individuals from the facility must be registered as a KS-HAN user with the ability to receive Health Alerts. https://kshealth.kdhe.state.ks.us/

    Date AAR/IP

    TASK Date of Exercise Submitted to KDHE #11 Participate (at the community, regional, or state level) in one tabletop,

    functional, or full-scale exercise that meets the minimum required medical surge components. An HSEEP After Action Report (AAR) and Improvement Plan (IP), that addresses the required capabilities, must be submitted to KDHE. The AAR/IP

    template can be found at www.kdhe-exercises.org. Exercise must be completed

    by June 1, 2012.

    Participated During Participated During Participated During Participated During

    Period 1 Period 2 Period 3 Period 4

    Yes or No Yes or No Yes or No Yes or No

    Date(s) Date(s) Date(s) Date(s) #12 Participate in at least one EMResource drill per period.

    Page 3 of 3

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