HEF

Health Department Resource Supply Form

Health Department Name(Required)

Evaluator Name(Required)

First Last

Evaluator Email(Required)

1. Upon notification of the incident, how long did it take your health department to assess available resources that you could commit to assist with the response?(Required)

2. How long did it take your health department to report available resources to the emergency operations center?(Required)

3. How many tetanus vaccines and oral injectable antibiotics were you able to send to assist with the response?

Tetanus shots(Required)

Antibiotics(Required)

4. How many staff members, including volunteers were you able to send to the scenes in response to the incident?(Required)