Disaster Response Crisis Intervention Report
General Information
Date:
Time:
Location:
Responder Name(s):
Agency/Organization:
Incident Details
Description of Disaster/Event:
Immediate Risks and Hazards:
Population Affected
Number of Individuals Affected:
Vulnerable Groups Identified:
Intervention Provided
Summary of Actions Taken:
Referrals Made:
Other Agencies Involved:
Observations & Outcomes
Situation Upon Arrival:
Progress & Outcomes:
Outstanding Needs/Follow-up Required:
Additional Notes