Public Health Emergency Preparedness

General Observation and Documentation Addendum

---

This module was developed by the Johns Hopkins Evidence-based Practice Center under Contract No. 290-02-0018 from the Agency for Healthcare Research and Quality, Rockville, MD. The content of this module is intended to provide guidance for hospital disaster drill evaluation and should not be construed as representing standards of care or recommendations on how to respond to specific types of disasters. No statement in this module should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

---

Instructions: Enter time and describe any activities in this zone related to the drill. This listing should include direct response to patients, information received, staffing, supplies, etc. It should also include any activities (such as real emergencies) that may delay or prevent drill activities in this zone.

Observer: ______________________________________________________________             Date: ____/____/____ Observer title: ___________________________________________________________ Zone: __________________________________________________________________ Hospital: _______________________________________________________________ Period of time of evaluation: _____________ AM / PM (Circle one) to _____________ AM / PM (Circle one)

Time	Activity/Observation

Return to Contents
Proceed to Next Section