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Event Information

Notice
Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.
Exercise?*
Was this a exercise or real event?
1. Exercise
2. Real Event
Type of Event*
Indicate the type of event that occurred. (Check the primary hazards)
1. Structure Fire
2. Other Fire
3. Hazmat - Transportation
4. Hazmat - Fixed Facility
5. Medical Emergency
6. Structural Collapse - Technical Rescue
7. Traffic Crash
8. Nuclear Power Accident
9. Winter Weather
10. Storm / Tornado
11. Flooding
12. Drowning or Water Accident
13. Planned Event (Festival, Fair, etc)
14. Criminal Action
15. Pandemic
16. Other
Date and Time Span*
Date and Time Span Start Date
Date and Time Span Start Time
—
Date and Time Span End Date
Date and Time Span End Time
Indicate the time span this "hotwash" covers. If you work multiple shifts, you should complete a "hotwash" after each shift.
OTHER?
Indicate the type of incident.
Event Address
City
State
Zip Code
City, Township, or Village of Event*
Summary of Event
Provide a short summary of the incident (including anything that affected you and your hotwash notes)
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First Name*
Last Name*
Agency Name*
Primary Email*
Batch Hotwash?
Are you submitting this form as a whole team or agency? (ie. Yes = you are including the whole team or agencies comments in one form. No = These are only my comments and the rest of the team or agency will submit their comments on a separate form)
1. Yes
2. No
Assignment and tasks
Summarize what you or your team did during this event. What was your assignment, what actions did you take?
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What could be improved?
Provide any feedback where improvement needs to be looked at.
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AAR Request*
Are you or your agency requesting the EMHSD to facilitate an After Action Review Meeting?
1. Yes
2. No
POC First Name
Who would we contact to set it up?
POC Last Name
POC Email
POC Best Telephone
POC Best Time to Call
When is the best time to call the POC? (ex 0800 -- 1700 daily)
Suggest Dates for AAR
Provide a list of dates and times that might best best to schedule for an AAR meeting. They typically will take 2-4 hours depending on how complex the incident was and how many people you invite.
Suggested Invitees
Provide a list of suggested invitees. If you have contact info of those suggested, it would be appreciated and helpful.

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