DMH / Disaster Planning and Preparedness Documents/Forms (downloadable)

John D. Weaver, LCSW

Developing disaster preparedness plans, writing letters of agreement, holding/participating in drills, and documenting team activities, are all very important aspects of DMH.  This page offers several time-saving preparedness documents and forms that can be downloaded and adapted to fit your needs.  Click on the form titles to view/download each one.

Assessing the Impacts

A simple, fill-in-the-blanks sheet to use in considering and documenting first impressions about the many physical, psychological, and sociological impacts a disaster has had on a community.  This information is useful in orienting the helpers and planning for ongoing relief efforts.

Coordinator Checklist

While writing my county mental health program's DMH plan, I tried to include lots of basic information to help those who may have to initiate and maintain a relief effort. These are some points to keep in mind when setting up, running, and ending an operation.

Disaster Event Log

A basic, fill-in-the-blanks sheet to recording ongoing activities during a disaster response.  It is a good idea to make some brief notes about what is happening every 15-30 minutes,  This helps maintain continuity as people come and go.  It also helps with after-action reviews and planning for future events.

Dispatcher and Responder Forms

These two forms are useful when documenting the activities of team members.  The Dispatcher Form is used to gather early referral information that is needed by initial responders and track who has been called into service.  The Responder Form is used by each DMH worker to record the background information.  The form then doubles as a statistics reporting form, a place to jot down brief notes about needed follow-up, and a record of who was on the job. 

DMH Worker Auto-kit (Preparedness Pack)

Everyone who has volunteered to serve as a DMH team member or volunteer should keep these items handy in case a rapid response is needed:

DMH Team Utilization Protocol

This protocol has been developed to help community leaders who are serving in a disaster/emergency relief and coordination roles decide when they may want to alert and/or request assistance from representatives of the DMH unit.  While use of the DMH team may be an obvious addition to any large-scale relief operations, it may be less obvious when to call for the team in incidents of a smaller scale. This includes some suggestions regarding disaster/emergency situations for which mental health consultation and intervention may be needed.

Emergency and Disaster Preparedness Checklist

This is a checklist of emergency/disaster preparedness information that can be used to assess your current readiness and then plug gaps, to add greater depth to your planning process.  It includes a long list of items to consider when putting together Ready Kits and Go Bags.  The material is drawn from information provided by the American Red Cross, FEMA, the National Organization on Disability, and several other organizations listed on the last page of the document.

Tracking Donations / Offers

A simple, fill-in-the-blanks form that can be used to track in-kind donations and offers of volunteer resources, equipment, and relief supplies.

Volunteer Log

A simple, fill-in-the-blanks form that can be used to track volunteer resources.

Writing & Reviewing MH Disaster Plans

This document can be used either as a fill-in-the-blank template for writing a MH disaster preparedness plan or as a helpful checklist for reviewing and updating DMH plans.

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During some EOTS training programs, we talk about non-disaster documents and forms that we use in other aspects of our work.  We have posted some of them on the Documents/Forms/Links (non-disaster) page.

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