EHPC Essential Elements of Information (EEI)

EHPC Essential Elements of Information (EEI)

This form is to be completed during a disaster or event
  • Date Format: MM slash DD slash YYYY
    Please complete the date your facility completed this form.
  • :
    Please complete the time your facility completed this form.
  • Please enter the email address of the person completing the form.
  • Please input the name of your hospital or organization
  • Please add a phone number where you can be reached for questions.
    Check the box that indicates your current status.
    Check the box that indicates your facilities structure stability.
    Does your facility have people there to just get oxygen?
  • Please enter a number from 0 to 100000.
    How many people are being "boarded" at your facility?
  • How many licensed beds does your facility have?
  • How many of your beds are currently staffed?
  • What is your current census of your facility?
  • How many Pediatric beds does your facility have.
  • How many Pediatric ICU beds does your facility have?
  • How many Nursery beds does your facility have?
  • How many NICU beds does your facility have?
  • How many ICU beds does your facility have?
  • How many Patients are on Ventilators in your facility?
  • How many patients are in your Emergency Department?
  • How many Adult Medical Surgical Floor Beds does your facility have?
  • How many Psychiatric Beds does your facility have?
  • How many Rehab Beds does your facility have?
  • How many extra staff is your facility housing?
    What type of power is your facility currently operating on?
    What type of fuel does your generator run on?
  • How much fuel is your facility storing that is available (Gallons)?
  • How long do you estimate your fuel supply to last in Hours?
    Is your HVAC functional at the current time?
    Is your communications currently operational?
  • Does your facility have any current needs for communications?
    Does your facility have a sufficient amount of Blood Products for this event?
  • What type of Blood Cells are you stocking and How many do you have on hand?
    What is the current status of your facilities operating room (if equipped)?
    Does your facility have a sufficient amount of water on hand?
  • Does your facility have a sufficient amount of food, if so how many days do you have on hand?
  • What is the capacity of your facilities morgue?
  • Please add any questions, notes, or information we may need to know or answer for your facility.
  • updated 1/13/2020