ICS Form 201

1. Incident Name 2. Date Prepared 3. Time Prepared

INCIDENT BRIEFING

4. Map Sketch

5. Prepared by (Name and Position)

ICS 201
Page 1 of 4
 6. Summary of Current Actions

ICS 201 Page 2

 7. Current Organization

ICS 201 Page 3

 8. Resources Summary
Resources Ordered Resource Identification ETA On Scene Location/Assignment

ICS 201 Page 4

 ICS Form 202

1. INCIDENT NAME 2. DATE 3. TIME

INCIDENT OBJECTIVES

4. OPERATIONAL PERIOD (DATE/TIME)

5. GENERAL CONTROL OBJECTIVES FOR THE INCIDENT (INCLUDE ALTERNATIVES)

6. WEATHER FORECAST FOR OPERATIONAL PERIOD

7. GENERAL SAFETY MESSAGE

8. Attachments ( if attached)
 Organization List (ICS 203)  Medical Plan (ICS 206)  Weather Forecast
 Assignment List (ICS 204)  Incident Map 
 Communications Plan (ICS 205)  Traffic Plan 

9. PREPARED BY (PLANNING SECTION CHIEF) 10. APPROVED BY (INCIDENT COMMANDER)

 Organization Assignment List, ICS Form 203

1. INCIDENT NAME 2. DATE PREPARED 3. TIME PREPARED

ORGANIZATION ASSIGMENT LIST
POSITION NAME 4. OPERATIONAL PERIOD (DATE/TIME)

5. INCIDENT COMMAND AND STAFF 9. OPERATIONS SECTION

INCIDENT COMMANDER CHIEF
DEPUTY DEPUTY
SAFETY OFFICER a. BRANCH I- DIVISION/GROUPS
INFORMATION OFFICER BRANCH DIRECTOR
LIAISON OFFICER DEPUTY
DIVISION/GROUP
6. AGENCY REPRESENTATIVES DIVISION/ GROUP
AGENCY NAME DIVISION/ GROUP
DIVISION/GROUP
DIVISION /GROUP

b. BRANCH II- DIVISIONS/GROUPS

BRANCH DIRECTOR
DEPUTY
DIVISION/GROUP
7. PLANNING SECTION DIVISION/GROUP
CHIEF DIVISION/GROUP
DEPUTY DIVISION/GROUP
RESOURCES UNIT
SITUATION UNIT c. BRANCH III- DIVISIONS/GROUPS
DOCUMENTATION UNIT BRANCH DIRECTOR
DEMOBILIZATION UNIT DEPUTY
TECHNICAL SPECIALISTS DIVISION/GROUP
DIVISION/GROUP
DIVISION/GROUP

8. LOGISTICS SECTION d. AIR OPERATIONS BRANCH

CHIEF AIR OPERATIONS BR. DIR.
DEPUTY AIR TACTICAL GROUP SUP.
AIR SUPPORT GROUP SUP.
HELICOPTER COORDINATOR
a. SUPPORT BRANCH AIR TANKER/FIXED WING CRD.
DIRECTOR
SUPPLY UNIT
FACILITIES UNIT
GROUND SUPPORT UNIT 10. FINANCE/ADMINISTRATION SECTION
CHIEF
DEPUTY
b. SERVICE BRANCH TIME UNIT
DIRECTOR PROCUREMENT UNIT
COMMUNICATIONS UNIT COMPENSATION/CLAIMS UNIT
MEDICAL UNIT COST UNIT
FOOD UNIT

PREPARED BY (RESOURCES UNIT)

 Sample Assignment List, ICS Form 204

1. BRANCH 2. DIVISION/GROUP
ASSIGNMENT LIST
3. INCIDENT NAME 4. OPERATIONAL PERIOD
DATE TIME

5. OPERATIONAL PERSONNEL
OPERATIONS CHIEF DIVISION/GROUP SUPERVISOR
BRANCH DIRECTOR AIR TACTICAL GROUP SUPERVISOR

6. RESOURCES ASSIGNED TO THIS PERIOD

DROP
NUMBER TRANS. PICKUP
STRIKE TEAM/TASK FORCE/ OFF
PERSONS NEEDED PT./TIME
RESOURCE DESIGNATOR EMT LEADER PT./TIME

7. CONTROL OPERATIONS

8. SPECIAL INSTRUCTIONS

9. DIVISION/GROUP COMMUNICATIONS SUMMARY

FUNCTION FREQ. SYSTEM CHAN. FUNCTION FREQ. SYSTEM CHAN.

LOCAL LOCAL
COMMAND SUPPORT
REPEAT REPEAT

DIV./GROUP GROUND
TACTICAL TO AIR
PREPARED BY (RESOURCE UNIT LEADER) APPROVED BY (PLANNING SECT. CH.) DATE TIME
 Sample Incident Communications Plan, ICS Form 205

1. Incident Name 2. Date/Time Prepared 3. Operational Period

Date/Time
INCIDENT RADIO COMMUNICATIONS PLAN

4. Basic Radio Channel Utilization

System/Cache Channel Function Frequency/Tone Assignment Remarks

5. Prepared by (Communications Unit)

 1. Incident Name 2. Date Prepared 3. Time Prepared 4. Operational Period
MEDICAL PLAN

5. Incident Medical Aid Station

Paramedics
Medical Aid Stations Location
Yes No

6. Transportation
A. Ambulance Services
Paramedics
Name Address Phone
Yes No

B. Incident Ambulances
Paramedics
Name Location
Yes No

7. Hospitals
Travel Time Helipad Burn Center
Name Address Phone
Air Ground Yes No Yes No

8. Medical Emergency Procedures

Prepared by (Medical Unit Leader) 10. Reviewed by (Safety Officer)

ICS 206
 Incident Commander

Safety Officer
Incident Name __________________________
Liaison Officer or Agency Representative Operational Period __________________________
Date ______________ Time ______________
Information Officer

Operations Section Chief Planning Section Chief Logistics Section Chief Finance Section Chief

Staging Area Manager

Communications Unit Leader Supply Unit Leader

Branch Director Branch Director Air Operations Director Resources Unit Leader

Time Unit Leader

Medical Unit Leader

Facilities Unit Leader

Division/Group Supervisor Division/Group Supervisor Air Support Supervisor Air Attack Supervisor Situation Unit Leader

Procurement Unit Leader

Food Unit Leader Ground Support Unit Leader

Division/Group Supervisor Division/Group Supervisor Helibase Manager Helicopter Coordinator Demobilization Unit Leader

Comp/Claims Unit Leader

Security Unit Leader

Division/Group Supervisor Division/Group Supervisor Helispot Manager Documentation Unit Leader

Air Tanker Coordinator
Cost Unit Leader

Division/Group Supervisor Division/Group Supervisor Fixed Wing Base Coordinator Technical Specialists

Division/Group Supervisor Division/Group Supervisor

ICS 207 NFES 1332

 INCIDENT STATUS SUMMARY (ICS 209)
*1. Incident Name: 2. Incident Number:
*3. Report Version (check *4. Incident Commander(s) & 5. Incident *6. Incident Start Date/Time:
one box on left): Agency or Organization: Management Date:
Organization:
☐ Initial Rpt # Time:
☐ Update (if used):
Time Zone:
☐ Final
7. Current Incident Size 8. Percent (%) *9. Incident 10. Incident *11. For Time Period:
or Area Involved (use unit Contained Definition: Complexity
label – e.g., “sq mi,” “city Level: From Date/Time:
block”): Completed To Date/Time:

Approval & Routing Information

*12. Prepared By: *13. Date/Time Submitted
Print Name: ICS Position: Time Zone:
Date/Time Prepared:

*14. Approved By: *15. Primary Location, Organization, or

Agency Sent To:
Print Name: ICS Position:
Signature:

Incident Location Information

*16. State: *17. County/Parish/Borough: *18. City:

19. Unit or Other: *20. Incident Jurisdiction: 21. Incident Location Ownership
(if different than jurisdiction):

22. Longitude (indicate format): 23. US National Grid Reference: 24. Legal Description (township, section,
range):
Latitude (indicate format):

*25. Short Location or Area Description (list all affected areas or a reference point): 26. UTM Coordinates:

27. Note any electronic geospatial data included or attached (indicate data format, content, and collection time information and
labels):

Incident Summary
*28. Significant Events for the Time Period Reported (summarize significant progress made, evacuations, incident growth, etc.):

29. Primary Materials or Hazards Involved (hazardous chemicals, fuel types, infectious agents, radiation, etc.):

30. Damage Assessment Information (summarize A. Structural B. # Threatened C. # D. #

damage and/or restriction of use or availability to Summary (72 hrs) Damaged Destroyed
residential or commercial property, natural resources, E. Single Residences
critical infrastructure and key resources, etc.):
F. Nonresidential
Commercial Property
Other Minor
Structures
Other

ICS 209, Page 1 of * Required when applicable.

 INCIDENT STATUS SUMMARY (ICS 209)
*1. Incident Name: 2. Incident Number:
Additional Incident Decision Support Information
A. # This A. # This
Reporting B. Total # Reporting B. Total #
*31. Public Status Summary: Period to Date *32. Responder Status Summary: Period to Date
C. Indicate Number of Civilians (Public) Below: C. Indicate Number of Responders Below:
D. Fatalities D. Fatalities
E. With Injuries/Illness E. With Injuries/Illness
F. Trapped/In Need of Rescue F. Trapped/In Need of Rescue
G. Missing (note if estimated) G. Missing
H. Evacuated (note if estimated) H. Sheltering in Place
I. Sheltering in Place (note if estimated) I. Have Received Immunizations
J. In Temporary Shelters (note if est.) J. Require Immunizations
K. Have Received Mass Immunizations K. In Quarantine
L. Require Immunizations (note if est.)
M. In Quarantine
N. Total # Civilians (Public) Affected: N. Total # Responders Affected:
33. Life, Safety, and Health Status/Threat Remarks: *34. Life, Safety, and Health Threat
Management: A. Check if Active
A. No Likely Threat ☐
B. Potential Future Threat ☐
C. Mass Notifications in Progress ☐
D. Mass Notifications Completed ☐
E. No Evacuation(s) Imminent ☐
F. Planning for Evacuation ☐
G. Planning for Shelter-in-Place ☐
35. Weather Concerns (synopsis of current and predicted H. Evacuation(s) in Progress ☐
weather; discuss related factors that may cause concern): I. Shelter-in-Place in Progress ☐
J. Repopulation in Progress ☐
K. Mass Immunization in Progress ☐
L. Mass Immunization Complete ☐
M. Quarantine in Progress ☐
N. Area Restriction in Effect ☐
☐
☐
☐
☐
36. Projected Incident Activity, Potential, Movement, Escalation, or Spread and influencing factors during the next operational
period and in 12-, 24-, 48-, and 72-hour timeframes:
12 hours:
24 hours:

48 hours:

72 hours:

Anticipated after 72 hours:

37. Strategic Objectives (define planned end-state for incident):

ICS 209, Page 2 of * Required when applicable.

 INCIDENT STATUS SUMMARY (ICS 209)
*1. Incident Name: 2. Incident Number:
Additional Incident Decision Support Information (continued)
38. Current Incident Threat Summary and Risk Information in 12-, 24-, 48-, and 72-hour timeframes and beyond. Summarize
primary incident threats to life, property, communities and community stability, residences, health care facilities, other critical
infrastructure and key resources, commercial facilities, natural and environmental resources, cultural resources, and continuity of
operations and/or business. Identify corresponding incident-related potential economic or cascading impacts.
12 hours:

24 hours:

48 hours:

72 hours:

Anticipated after 72 hours:

39. Critical Resource Needs in 12-, 24-, 48-, and 72-hour timeframes and beyond to meet critical incident objectives. List resource
category, kind, and/or type, and amount needed, in priority order:
12 hours:

24 hours:

48 hours:

72 hours:

Anticipated after 72 hours:

40. Strategic Discussion: Explain the relation of overall strategy, constraints, and current available information to:
1) critical resource needs identified above,
2) the Incident Action Plan and management objectives and targets,
3) anticipated results.
Explain major problems and concerns such as operational challenges, incident management problems, and social,
political, economic, or environmental concerns or impacts.

41. Planned Actions for Next Operational Period:

42. Projected Final Incident Size/Area (use unit label – e.g., “sq mi”):
43. Anticipated Incident Management Completion Date:
44. Projected Significant Resource Demobilization Start Date:
45. Estimated Incident Costs to Date:
46. Projected Final Incident Cost Estimate:
47. Remarks (or continuation of any blocks above – list block number in notation):

ICS 209, Page 3 of * Required when applicable.

 INCIDENT STATUS SUMMARY (ICS 209)
1. Incident Name: 2. Incident Number:
Incident Resource Commitment Summary

50. Additional Personnel

49. Resources (summarize resources by category, kind, and/or type; show # of
resources on top ½ of box, show # of personnel associated with resource on 51. Total
bottom ½ of box): Personnel
(includes those

not assigned to a
associated
with resources
– e.g., aircraft

resource:
or engines –
48. Agency or and individual
Organization: overhead):

52. Total Resources

53. Additional Cooperating and Assisting Organizations Not Listed Above:

ICS 209, Page of * Required when applicable.

 ICS Form 211

INCIDENT CHECK-IN LIST 1. Incident Name 2. Check-In Location (complete all that apply) 3. Date/Time

Check one: Base Camp Staging Area ICP Restat Helibase

Personnel Handcrew Misc.
Engines Dozers
Helicopters Aircraft

Check-In Information
4. List Personnel (overhead) by Agency & Name -OR- 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 16. 16.
List equipment by the following format:
Order/Request Date/ Time Total No. Manifest Crew or Departure Point Method of Incident Sent to
Agency Single Kind Type I.D. No/Name Number Check-In Leader’s Name Personnel Yes No Individual’s Home Base Travel Assignment Other RESTAT
Weight Qualifications Time/Int

17. Prepared by (Name and Position) Use back for remarks or comments
Page ___ of ____
 ICS 213

GENERAL MESSAGE
TO: POSITION:

FROM: POSITION:

SUBJECT: DATE: TIME:

MESSAGE:

SIGNATURE: POSITION:

REPLY:

DATE: TIME: SIGNATURE/POSITION:

 1. Incident Name 2. Date Prepared 3. Time Prepared
UNIT LOG
4. Unit Name/Designators 5. Unit Leader (Name and Position) 6. Operational Period

7. Personnel Roster Assigned

Name ICS Position Home Base

8. Activity Log
Time Major Events

9. Prepared by (Name and Position)

ICS 214
 ICS Form 215

1. Incident Name 2. Date Prepared 3. Operational Period (Date/Time)

Time Prepared
OPERATIONAL PLANNING WORKSHEET

4. 5. Resource by Type 6. 7.
Division/Group or Work Assignments (Show Strike Team as ST) Reporting Location Requested
Other Location Arrival Time

Req

Have

Need

Req

Have

Need

Req

Have

Need

9. Req
Total Resources - Single
Have

Need

Req
Prepared by (Name and Position)

Total Resources - Strike Teams Have

Need
 Incident Action Plan Safety & Risk Analysis Form, ICS 215A

INCIDENT ACTION PLAN SAFETY 1. Incident Name 2. Date 3. Time

ANALYSIS

Division or Group Potential Hazards Mitigations (e.g., PPE, buddy system, escape routes)

Type of Hazard:
Type of Hazard:
Type of Hazard:
Type of Hazard:
Type of Hazard:
Type of Hazard:
Type of Hazard:
Type of Hazard:

Prepared by (Name and Position)

 1. Incident Name 2. Date 3. Time
RADIO REQUIREMENTS WORKSHEET
4. Branch 5. Agency 6. Operational Period 7. Tactical Frequency

8. Division/Group Division/Group Division/Group Division/Group

Agency Agency Agency Agency

9. Agency ID No. Radio Requirements Agency ID No. Radio Requirements Agency ID No. Radio Requirements Agency ID No. Radio Requirements

10. Prepared by (Name and Position)

Page 1 of

ICS 216 NFES 1339

 SUPPORT VEHICLE INVENTORY 1. Incident Name 2. Date Prepared 3. Time Prepared
(Use separate sheet for each vehicle category)

Vehicle Category: Buses Dozers Engines Lowboys Pickups/Sedans Tenders Other

Vehicle/Equipment Information
Resource Order No. Vehicle License
“E” Number Incident ID No. Vehicle Type Vehicle Make Capacity Size Agency/Owner Rig Number Location Release Time

5. Prepared by (Ground Support Unit)

Page ___of ____

SUPPORT VEHICLE INVENTORY 1. Incident Name 2. Date Prepared 3. Time Prepared

(Use separate sheet for each vehicle category)

ICS 218 NFES 1341

 Vehicle Category: Buses Dozers Engines Lowboys Pickups/Sedans Tenders Other

Vehicle/Equipment Information
Resource Order No. Vehicle License
“E” Number Incident ID No. Vehicle Type Vehicle Make Capacity Size Agency/Owner Rig Number Location Release Time

5. Prepared by (Ground Support Unit)

Page ___of ____

ICS 218 NFES 1341

 GREEN CARD STOCK (CREW)

AGENCY ST KIND TYPE I.D. NO. AGENCY TF KIND TYPE I.D. NO./NAME

ORDER/REQUEST NO. DATE/TIME CHECK IN

INCIDENT LOCATION TIME

HOME BASE
STATUS
ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR

DEPARTURE POINT

NOTE

LEADER NAME

INCIDENT LOCATION TIME

CREW ID NO./NAME (FOR STRIKE TEAMS)

STATUS
ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR

NOTE

NO. PERSONNEL MANIFEST WEIGHT

INCIDENT LOCATION TIME
YES NO

METHOD OF TRAVEL

OWN BUS AIR STATUS

ASSIGNED O/S REST O/S PERS.
OTHER

AVAILABLE O/S MECH ETR

DESTINATION POINT ETA

NOTE

TRANSPORTATION NEEDS
INCIDENT LOCATION TIME
OWN BUS AIR

OTHER

ORDERED DATE/TIME CONFIRMED DATE/TIME STATUS

ASSIGNED O/S REST O/S PERS.

REMARKS
AVAILABLE O/S MECH ETR

NOTE

ICS 219-2 (Rev. 4/82) CREW NFES 1344 *U.S. GPO: 1990-794-001
 BLUE CARD STOCK (HELICOPTER)

AGENCY ST KIND TYPE I.D. NO. AGENCY TYPE MANUFACTURER I.D. NO.

ORDER/REQUEST NO. DATE/TIME CHECK IN

INCIDENT LOCATION TIME

HOME BASE

STATUS
ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR

DEPARTURE POINT

NOTE

PILOT NAME

INCIDENT LOCATION TIME

DESTINATION POINT ETA

STATUS
ASSIGNED O/S REST O/S PERS.

REMARKS AVAILABLE O/S MECH ETR

NOTE

INCIDENT LOCATION

INCIDENT LOCATION TIME

STATUS
ASSIGNED O/S REST O/S PERS.
STATUS
AVAILABLE O/S MECH ETR ASSIGNED O/S REST O/S PERS.

NOTE AVAILABLE O/S MECH ETR

NOTE

INCIDENT LOCATION TIME

INCIDENT LOCATION TIME

STATUS
ASSIGNED O/S REST O/S PERS. STATUS
ASSIGNED O/S REST O/S PERS.
AVAILABLE O/S MECH ETR
AVAILABLE O/S MECH ETR
NOTE

NOTE

ICS 219-4 (Rev. 4/82) HELICOPTER NFES 1346 *U.S. GPO: 1988-594-771 NFES 1346
 ORANGE CARD STOCK (AIRCRAFT)

AGENCY TYPE MANUFACTURER I.D. NO. AGENCY TYPE MANUFACTURER I.D. NO.
NAME/NO.

ORDER/REQUEST NO. DATE/TIME CHECK IN

INCIDENT LOCATION TIME

HOME BASE

STATUS
ASSIGNED O/S REST O/S PERS.

DATE TIME RELEASED AVAILABLE O/S MECH ETR

NOTE

INCIDENT LOCATION TIME

INCIDENT LOCATION TIME

STATUS
ASSIGNED O/S REST O/S PERS.
STATUS
AVAILABLE O/S MECH ETR ASSIGNED O/S REST O/S PERS.

NOTE
AVAILABLE O/S MECH ETR

NOTE

INCIDENT LOCATION TIME

INCIDENT LOCATION TIME

STATUS
ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR

STATUS
ASSIGNED O/S REST O/S PERS.
NOTE
AVAILABLE O/S MECH ETR

NOTE
INCIDENT LOCATION TIME

INCIDENT LOCATION TIME

STATUS
ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR

STATUS
NOTE ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR

NOTE

ICS 219-6 (4/82) AIRCRAFT *U.S. GPO: 695-162-1986 NFES 1348

 YELLOW CARD STOCK (DOZERS)

AGENCY ST TF KIND TYPE I.D. NO. AGENCY ST TF KIND TYPE I.D. NO.

ORDER/REQUEST NO. DATE/TIME CHECK IN

INCIDENT LOCATION TIME

HOME BASE
STATUS
ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR

DEPARTURE POINT

NOTE

LEADER NAME

INCIDENT LOCATION TIME

RESOURCE ID. NO.S/NAMES

STATUS
ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR

NOTE

DESTINATION POINT ETA

INCIDENT LOCATION TIME

REMARKS
STATUS
ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR

NOTE
INCIDENT LOCATION TIME

INCIDENT LOCATION TIME

STATUS
ASSIGNED O/S REST O/S PERS.

AVAILABLE O/S MECH ETR STATUS

ASSIGNED O/S REST O/S PERS.
NOTE

AVAILABLE O/S MECH ETR

NOTE

ICS 219-7 (Rev. 4/82) DOZERS NFES 1349 *U.S. GPO: 1990-794-006
 1. Incident Name Helibases
AIR OPERATIONS SUMMARY
Fixed Wing Bases

4. Personnel and Communications Name Air/Air Frequency Air/Ground Frequency 5. Remarks (Spec. Instructions, Safety Notes, Hazards, Priorities)
Air Operations Director

Air Attack Supervisor

Helicopter Coordinator

Air Tanker Coordinator

6. Location/Function 7. Assignment 8. Fixed Wing 9. Helicopters 10. Time 11. Aircraft 12. Operating
No. Type No. Type Available Commence Assigned Base

13. Totals

14. Air Operations Support Equipment 15. Prepared by (include Date and Time)

ICS 220 NFES 1351

 DEMOBILIZATION CHECKOUT
1. Incident Name/Number 2. Date/Time 3. Demob. No.

4. Unit/Personnel Released

5. Transportation Type/No.

6. Actual Release Date/Time

7. Manifest? Yes No Number

8. Destination 9. Notified: Agency Region Area Dispatch

Name:

Date:
10. Unit Leader Responsible for Collecting Performance Rating

11. Unit/Personnel
You and your resources have been released subject to sign off from the following:
Demob. Unit Leader check the appropriate box
Logistics Section

Supply Unit

Communications Unit

Facilities Unit

Ground Support Unit Leader

Planning Section

Documentation Unit

Finance Section

Time Unit

Other

12. Remarks

DEMOBILIZATION CHECKOUT
1. Incident Name/Number 2. Date/Time 3. Demob. No.

4. Unit/Personnel Released

5. Transportation Type/No.

ICS 221 NFES 1353

 6. Actual Release Date/Time
7. Manifest? Yes No Number

8. Destination 9. Notified: Agency Region Area Dispatch

Name:

Date:
10. Unit Leader Responsible for Collecting Performance Rating

11. Unit/Personnel
You and your resources have been released subject to sign off from the following:
Demob. Unit Leader check the appropriate box
Logistics Section

Supply Unit

Communications Unit

Facilities Unit

Ground Support Unit Leader

Planning Section

Documentation Unit

Finance Section

Time Unit

Other

12. Remarks

DEMOBILIZATION CHECKOUT
1. Incident Name/Number 2. Date/Time 3. Demob. No.

4. Unit/Personnel Released

5. Transportation Type/No.

6. Actual Release Date/Time

7. Manifest? Yes No Number

8. Destination 9. Notified: Agency Region Area Dispatch

Name:

Date:
10. Unit Leader Responsible for Collecting Performance Rating

11. Unit/Personnel

ICS 221 NFES 1353

You and your resources have been released subject to sign off from the following:
Demob. Unit Leader check the appropriate box
Logistics Section

Supply Unit

Communications Unit

Facilities Unit

Ground Support Unit Leader

Planning Section

Documentation Unit

Finance Section

Time Unit

Other

12. Remarks

13. Prepared by (include Date and Time)

NFES 1353 ICS 221

 Instructions for completing the Demobilization Checkout (ICS form 221)
Instructions for completing the Demobilization Checkout (ICS form 221)

Prior to actual Demob Planning Section (Demob Unit) should check with the Command Staff (Liaison Officer) to determine any
agency specific needs related to demob and release. If any, add to line Number 11.

Item No. Item Title Instructions

1. Incident Name/No. Enter Name and/or Number of Incident.

2. Date & Time Enter Date and Time prepared.

3. Demob. No. Enter Agency Request Number, Order Number, or Agency Demob Number if
applicable.

4. Unit/Personnel Released Enter appropriate vehicle or Strike Team/Task Force ID Number(s) and Leader’s name
or individual overhead or staff personnel being released.

5. Transportation Enter Method and vehicle ID number for transportation back to home unit. Enter N/A
if own transportation is provided. Additional specific details should be included in Remarks,
block # 12.

6. Actual Release Date/Time To be completed at conclusion of Demob at time of actual release from incident. Would
normally be last item of form to be completed.

7. Manifest Mark appropriate box. If yes, enter manifest number. Some agencies require a manifest
for air travel.

8. Destination Enter the location to which Unit or personnel have been released. i.e. Area, Region,
Home Base, Airport, Mobilization Center, etc.

9. Area/Agency/ Identify the Area, Agency, or Region notified and enter date and time of notification.
Region Notified

10. Unit Leader Responsible for Self-explanatory. Not all agencies require these ratings.
Collecting Performance Ratings

11. Resource Supervision Demob Unit Leader will identify with a check in the box to the left of those units
requiring check-out. Identified Unit Leaders are to initial to the right to indicate
release.

Blank boxes are provided for any additional check, (unit requirements as needed), i.e.
Safety Officer, Agency Rep., etc.

12. Remarks Any additional information pertaining to demob or release.

13. Prepared by Enter the name of the person who prepared this Demobilization Checkout, including
the Date and Time.

ICS 221 NFES 1353