Disaster Response Psychological First Aid Template

1. Basic Information

Name: Date: Location:

2. Situation Summary

Brief Description of Disaster/Incident:

3. Immediate Psychological Needs

Describe Immediate Needs/Concerns:

4. Support Provided

Practical Support Given:

5. Emotional Support

Actions to Comfort and Soothe:

6. Coping Strategies Discussed

Coping Techniques or Resources Shared:

7. Referrals and Follow-Up

Agencies/Personnel Referred to: Follow-Up Plan:

8. Additional Notes

Observations / Recommendations: