CERT Form 1
Damage Assessment Form
The Damage Assessment Form is the most basic and essential form in a volunteer’s kit. A volunteer uses the form to record damage observed in a neighborhood (such as fires, utility hazards, structural damage, injuries and casualties, and available access) while moving through the area to their staging area.
Upon arriving at the staging area, the volunteer turns the Damage Assessment Form in to the Team Leader. The Team Leader then uses all the Damage Assessment Forms turned in to formulate and prioritize action plans (reflected on Form 4: Team Leader’s Assignment Tracking Log).
CERT Form 2A
Personnel Check-In
The Personnel Check-in form is used to record and track incoming CERT members as well as affiliated volunteers (e.g. ATVs) and spontaneous volunteers (e.g. SUVs). It helps the Team Leader or the Logistics section understand:
- Who is on site
- When they arrived
- When/where they were assigned
- Personnel availability
A space is provided for an Assignment Tracking Number if a volunteer is given a field assignment with a tracking number (see NET Form 4).
This form is used by a volunteer assigned to check other volunteers in. This could be the CERT scribe, but this is also an appropriate task for an SUV.
A special note on check out times: please be sure that all volunteers check out! A volunteer who does not check out is effectively “missing” and unaccounted for, which can lead to a waste of time and resources attempting to locate the volunteer.
CERT Form 2B
Spontaneous Volunteer Intake
Teams can track spontaneous unaffiliated volunteers (SUVs) using CERT Form 2A; however, in addition, CERTs must intake SUVs using this form. This intake form reflects recommendations for managing SUVs. It also helps SUVs understand what may be expected of them during disaster response operations and helps protect the City from liability.
CERT Form 3
Team Leader Assignment Tracking
CERT Form 3 is a “dashboard” that the Team Leaders use to track active field assignments; it is a tool to facilitate situational awareness.
When at a staging area, volunteers turn in their damage assessment forms (Form 1). The TL uses information from the collected assessment forms to make decisions on where to deploy resources. Form 3 summarizes and tracks where those resources go.
CERT Form 4
Assignment Briefing
The purpose of CERT Form 4 is to provide a team deploying to an operation with relevant information about the mission, and to record the details of mission results for the Team Leader and professional responders
CERT Form 5A
Patient Treatment Area Record
The Patient Treatment Area Record is a specialized form intended to track the condition of patients placed in a patient treatment area. It is filled out by a volunteer (CERT or SUV) detailed to the treatment area. Completed Treatment Area Records are turned in to the CERT’s Scribe.
This form does not allow for a great deal of detail on victims’ conditions. This is acceptable for an immediate, short-term response when the presumption that emergency medical response will soon be en route.
However, if volunteers anticipate that professional responders will not be available for some time, a designated volunteer should consider tracking treatment area patients using this form as a dashboard while tracking the condition of individual patients using Form 5B: Individual Treatment Record.
CERT Form 5B
Individual Treatment Record
The Individual Treatment Record is a specialized form intended to track the specific observations and treatments provided to an individual patient place in a patient treatment area. It is filled out by the volunteer(s) (CERT or ATV/SUV) detailed to provide individual care. Completed treatment records should go with the individual when they move to a higher level of care, with a copy (physical or electronic) turned in to the CERT’s Scribe.
The form is designed to be used by volunteers with basic medical training. It has two major purposes:
- The form serves as a guide to structure the initial examination of the patient and the gathering of relevant medical information.
- The form serves as a record of the findings discovered, the observations made, and the treatments provided by the volunteer medical personnel. This information is critical for medical personnel that may receive the patient later in the process.
Use as many pages as necessary to document findings.
CERT Form 6
Communications Log
The Communication Log tracks significant radio activity for each radio at a particular location. Logged activities should include:
- When the operator checks into or out of a net
- When the operator changes frequency
- When operator and logger changeswith name and callsign of new person
- When the operator takes more than a 10 minute break
- Any significant event involvingoperation of this radio
- When the operator goes off the air.
CERT Form 7
Equipment Inventory
If a team has a sizeable equipment cache, we recommend using this form to track team items as they are checked out and checked back in. This is particularly true of major assets.
Consider delegating equipment responsibilities to a designated CERT volunteer, or even an SUV. The forms should be kept with the equipment cache, and turned in to the Logistics section when completed.
Like tracking numbers, Asset Numbers are purely optional. If a team wishes to use asset numbers to help track tools and supplies, space is provided.
CERT Form 8
General Message
General Message forms are used to send messages and responses via “runner” if radio communications are not available.
There are actually two forms per sheet, front and back. The sender writes a message on the front side, tears it in half, and gives it to a runner. The runner takes the paper to the receiver, and the receiver writes a response on the reverse side.
After the correspondence is completed, the message form should be turned in to Logistics and kept as part of the response record.