Wufoo

MCPS ERCM After- Action Report Form

ERCM Incident/Drill After Action Narrative Report and Evaluation.
This form should be used after a critical incident, and may also be used to evaluate a drill or other event that tests any aspect of the school or district's emergency response plan. If possible, the form should be completed individually by each member of the school ERCM/Safety Team, and may be given to all staff or a sampling of staff based on the nature of the incident or situation being evaluated. Please submit this form to the MCPS office of Student Support Services within one week of the incident or drill.

Person Completing Report: First Last
Position:
School (Choose from list below):
Where were you and what was your assigned task during the event?
Date of the Event: / MM / DD YYYY
Date of the Report: / MM / DD YYYY
I. Narrative Descriptions

A. The Event (Describe the nature, scope, and magnitude of the event or incident)

Drill:
Yes No

Time: Start of the Incident or Drill : HH : MM SS AM/PM

End of Incident or Drill: : HH : MM SS AM/PM

B. Activities (Describe the activities and services performed during the event or incident). Was an outlined procedure followed, and if so, did it adequately address the situation?)

C. Coordination: Participating Agencies
Local Police Department (Please name) Virginia Police Department Mecklenburg Co Sherriffs Dept Mecklenburg Co Dept of Social Services Other Social Services Virginia Health Dept Local Clinic Doctor (Please name) Local Fire Dept (Please Name) Local Rescue Squad (Please name) SS Community Services Board-Mental Health School Psychologist(s) External School Guidance Counselor (Please name the school) Central Office Staff (Please name) Federal Agency (Please name) Local Business (Please name) Other (Please name)

If your choices selected above included:(Please name) Use the designated space below to provide that information.

Recommendations for Coordination:

D. Personnel/Training (Was there sufficient personnel to handle the situation, and was training adequate? Explain.)

Recommendations for Personnel/Training:

E. Logistics (Review relevant issues such as: food, transportation, expenses, distinctive clothing, protective equipment, communications equipment, mail, student medications, health issues, injuries, etc)

Recommendations for Logistics:

F. Significant or Unusual Factors (Describe events, issues, conditions, needs, or personnel that had significant, unusual, or unique influence on the outcome of this event, postive or negative.)

Part II - Lessons Learned

Please note any additional lessons learned. (Was there something in this experience that you feel must be addressed, changed, prepared for, or removed from future responses?)

Attachments:

(Include any articles, forms, reports, handouts,etc. that you would like to share)

Do Not Fill This Out

Wufoo

MCPS ERCM After- Action Report Form

I. Narrative Descriptions

Part II - Lessons Learned