Infectious Disease Incident Action Plan Form
Use this form to document and plan operational actions for an infectious disease incident. Please complete all fields to support effective incident management.
Incident Name or Identifier
*
Incident Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reporting Location or Facility
*
Disease or Pathogen Name
*
Incident Type/Status
*
Suspected
Confirmed
Ongoing
Resolved
Other
Current Situation Summary
*
Immediate Actions Taken
*
Resources or Personnel Needed
*
Responsible Coordinator
*
Follow-up Action Plan or Next Steps
*
Submit Action Plan
Should be Empty: