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Relief Management Organogram

Introduction

Emergency Response Framework (ERF) is developed to help and guide for

conducting all-hazards emergency disaster response. This framework has

adopted best practices drawn from various experiences and explains the

common discipline and system that have been exercised and matured over

various emergency response experiences by Disaster Management &

Mitigation Unit (DMMU) and learning from other emergency relief

organizations. This can be used as a ready-reckoner for an organization facing

sudden emergency disaster situation requiring to respond to. It also provides

benchmark for implementing emergency response with justice, fairness and

equity. As part of the organizational mandate on mainstreaming disability we

have included the rights of persons with disabilities in all possible spheres.

Primarily this booklet was developed to provide guide to Disaster Response

Centers identified as part of the Disaster Preparedness pilot project in the

Northeastern region of India during 2009-2011, supported by CBM and BGRi.

However, this first edition is the outcome of the review undertaken by DMMU

team during 2012. This guide is now made available for Units of Emmanuel

Hospital Association (EHA). I appreciate my colleagues R. K. Shem and

Cornelius Ngade for their inputs.

This guide containing multiple supporting documents, forms & templates

complying with accepted norms, standards and best practices, commonly used

by disaster management practitioners globally, can be treated as a pre-cursor

to a full-fledged Emergency Response Protocol in near future.

Peniel Malakar

Central Coordinator,

Disaster Management & Mitigation Unit.

Foreword

It is a privilege to publish the EHA Disaster management operational

guidelines booklet, and make this available to all. Though many of these

standards have been in effect for many years in EHA, they have now been

compiled with additional templates and forms based on our experiences and

prevalent best practices. Care has been taken to include all marginalized

communities with special focus on persons with disabilities.

Many of EHA hospitals and community development projects have been

affected by various disasters as they are located in disaster prone areas. This

book let with details of information, forms and templates are expected to guide

to respond to the potential disasters of various magnitudes.

Quick decision making is an important factor for ensuring reduction in

response time. Information provided in this booklet would help achieve rapid,

effective and relevant response to any disaster situation. It is my hope that

these guidelines will enable one to approach emergency disaster response in a

more systematic and uniform manner achieving optimal alleviation of

suffering of disaster victims.

Dr. Mathew Santhosh Thomas. MD. Executive Director. Emmanuel Hospital Association.

Contents

Introduction

Foreword

Background ................................................................................... 1

Emergency Response Template .................................................... 5

Forms & Templates ........................................................................ 8

Initial Assessment Form .............................................................. 12

Rapid Spot Assessment ................................................................ 13

Team Formation Format ............................................................. 18

Household Beneficiary Survey Form ...........................................20

Volunteer Application Form ........................................................ 22

Volunteer Pledge .......................................................................... 23

Know Your Volunteer .................................................................. 24

Volunteer Checklist ...................................................................... 26

Procurement Form ....................................................................... 27

International Decision Making Process ...................................... 29

Emergency Response Flow Chart ................................................ 30

Emergency Response Framework – a guide 1

DMMU. Nehru Place. New Delhi. 110019

Background

India, during this decade has been marked by a series of devastating disasters

that have captured global attention, most notably the Indian Ocean tsunami, the South

Asia earthquake in Jammu & Kashmir, Koshi floods in Bihar and series of bomb

2 Emergency Response Framework – a guide


blasts causing major civil unrest in Northeast and other Indian states including the

national capital Delhi. While the decade will often be associated with these major

natural as well as man-made tragic events, it is also important to note the impact of

numerous other disasters like building collapsed, major fire in factories, schools,

hospitals etc. alongside increasing number of road accidents have caused a massive

loss of lives and property.

The ever increasing trend in disasters as well as lack of preparedness for systematic

response led to delay and ineffective response causing huge loss and damage.

Prior to 2006, EHA responded to the humanitarian crisis on ad hoc basis. During the

decade frequency of disaster events increased with the number of EHA Units heavily

affected by floods. With the DMMU team formed during the same year, it was able to

formulate systematic ways to respond to disaster emergencies improving on the

response time. However, an Emergency Response Framework (ERF) was initially

developed with various essential forms and templates as a guide to EHA's emergency

response that was upgraded with experiences learned during the decade.

The main objective of the framework is to ensure emergency response operations are

conducted in extremely efficient manner.

This procedure is primarily based on the incident command/respond system that

ensures discipline and systematic response to an emergency situation. Each step

mentioned here needs to be essentially followed to achieve maximum benefit to

alleviate suffering of disaster victims ensuring justice, fairness and equity.

The procedure given below contains important information and measures as the

guiding tool that would ensure a disaster emergency responder achieve its objectives

fulfilling basic humanitarian practices:

Directories- this contains all contact details of the Organization head office and main contact person (Incident Commander)

Person in overall charge/ Relief Officer

Local office contact

Contact details of other team members

Core Relief Team members

Sectional in-charges as per the Incident Command/Response System

operations

planning

logistics

finance



Local district administration including administration, police, health

officials, emergency officials etc.

Local panchayat leaders and or other leaders – where we are intending to

respond to

NGOs/INGOs, IAG etc.

All other essential services- transport, suppliers, hospitals, emergency

doctors, schools/colleges

Important inventories

list of materials, equipments, documents etc.

Details of vehicles and other major assets

Vehicle

details of vehicle including registration, insurance, taxes copies

drivers valid DL with fresh photograph and contract number

others

Organogram and flow charts

Emergency Response Organogram (with persons responsible and JDs)

Flow chart showing relief operation flow including procurement to

distribution planning

Checklists Team kit

FA

Safety gears

Volunteers Management kits

Minimum Standard document, guidelines etc.

Donor specific guidelines on

finance (for example, FPA of ECHO)

minimum requirements

Code of conduct

volunteers & NGO code of conduct

Map, Charts/statistics etc.

state and district

affected location with as much as details available such as

govt office (Block)

panchayat office location

health center

ICDS/community center



school, college

religious centers

FCI or large food storage, PDS location, cold storage

markets, common locations

river, drain, water bodies, dam

local road linking to main road and NH

high alleviated locations such as National Highways, Railway

tracks, small hills etc.

Specific danger areas such as

chemical factories

fire work industries

Information charts showing overall statistics of

District demography (population, gender, block, villages,

households, panchayat etc.)

Total no. of affected and displaced population

No. of death, missing & injured

No. of temporary shelters

NGOs/INGOs involved with sector and target areas/ no of days to

be covered

Your target villages with details

Your relief plan with details of days/families etc.

Supplier details and stock locations

Other details such as

Total number of teams

Volunteers

outside

local

Lay-out of Relief Center (Emergency Operations Center) Relief admin office

Residential

Ware house/store house

Parking areas

Main water source

PRO or public information center

Mess

Security

Entry/Exit



Emergency Response Template

1. Needs and Damage Assessment:

1. Immediate situation report/ Initial Assessment report:

1. telephone

2. internet news, Alert net, relief web

3. local news papers

4. local partner

5. government sources

6. Inter Agency Groups (IAG) – SITREP

2. Rapid Spot Assessment team formed with the followings(24-72hrs):

(recommend EHA & Sphere India formats)

1. Sectoral expert

2. Experienced person (pre-identified by the org)

3. Women representation

4. Representation from PWD

5. Local community

6. Local partners

3. Networking

1. local govt. officials (relevant field)

2. responding NGOs/INGOs/IAG-coordination

3. media

4. other stakeholders

2. Team formation 1. Emergency Relief Committee (ERC), Delhi

2. Rapid Assessment Team

3. Core Relief Team

4. Village Relief Committee

5. Purchase Committee

6. Quality Control Group.

3. Emergency Response Plan 1. Immediate Action Plan (seed funding)

2. Emergency Appeal (EA) with initial budget for mobilizing fund

3. Review of action plan based on continuous assessment

4. Draw MoU with local partner

5. Launch team with clear job descriptions

6. Team insurance and other requirements



4. Volunteer mobilization

1. Assess total requirement of volunteers in specific area

2. Send requisition/raise volunteer accordingly

3. On arrival of volunteers, following important procedures need to be

followed-

1. Registration process

1. Signing up VAF (new volunteers)

2. Filling up KYV

3. Signing of Code of Conduct/Pledge

2. Event registration process

1. Induction on

1. Organization

2. Relief operation & Tasks

3. Other core information

5. Procurement & Warehouse

1. Activating Purchase Committee as per EHA protocol

2. Assess supply requirements in detail with full specification and quantity

3. Collect price quotations (at least 3) with full specifications from different

suppliers with sample

4. Raise Purchase Order with all required details/packaging, transportation,

complying with current legal provisions (applicable taxes, insurance and

documents)

5. Post order on the basis of Purchase Committee decision with 'samples'

6. Finalize stores location in advance with important considerations such as

1. storage capacity

2. safety

3. nearness to final distribution point

4. rates etc.

7. Important documents essential to

1. MoU with supplier

2. Transport agreement- rate, insurance, taxes etc.

3. MoU on Warehouse & Storage space

4. Tax Exemption circular from State/Central Govt. (in case of such

declaration)

6. Documentation/Reporting & Monitoring 1. Documentation- follow donor specific instructions including finance

1. generate daily, weekly, monthly reports

2. photography & video

3. media reports



4. daily updates to HQ

5. donor specific finance reporting format

2. Monitoring- activities and finance

1. weekly monitoring- sector specific

2. continuous assessment (in case of course correction required)

3. quality control – following minimum standard practices

4. equity, transparency, accountability – most vulnerable groups

(gender, PWD, age, marginalized etc.)



Forms and Templates

1. Assessments: This is the first and most critical part of an emergency disaster

response processes. Based on this overall plan for disaster relief is prepared.

They can be of two types:

a) Initial Assessment (IA) – Initial Assessment is carried out within the

first 24 hours following a disaster. It is essential to acquire situation

report and to inform immediate relief needs and shared immediately. It

helps to establish a starting point of response program.

b) Rapid Spot Assessment (RSA) – Initial assessment is followed by a

more complete rapid spot assessment as early as possible (within day 3-

5 days) after the disaster. The RSA provides the basis for subsequent in-

depth assessments that deepen earlier findings. This should help in

determining the extent of the damages and urgent needs and priorities,

and actual response measures to be taken by the responding organization.

Rapid Spot Assessment Team (RAT) – consists people with skills in

various sectors, (Health, food/nutrition, shelter, WatSan) trained

volunteers and local people.

c) Initial Action Plan (IAP) – This plan is drawn based on the initial

assessment and includes initial relief plan while RSA in progress and

before the final assessment report leading to emergency response

program. The purpose of IAP is to meet immediate basic needs of

disaster victims using seed funding, if available.

2. Household (beneficiary) Survey form: The primary purpose of conducting

HS is to identify the exact number of beneficiaries (affected family requiring

aids) in the target villages based on the information and data collected during

the Rapid Spot Assessment. Household surveys are an important source of

collecting on spot information on socio-economic, livelihood, health and

infrastructure damages caused by the events. It also provides good data and

information to plan for long-term reconstruction interventions.

3. Beneficiary Card: BC is provided to all the needy families during

conducting the household survey. With this card the family can claim their

benefit during the distribution of relief materials at a given time period.

4. Agreement templates: These are ready to use templates as Memorandum of

Understanding or Agreements with the local partner/EHA Unit

concerned/agencies, suppliers on purchases, large warehousing, and even

transport agreements, which includes all basic and legal elements of an



agreement. We have also included a ready to use customizable Rate Chart,

which can be conveniently used in any of these MoUs. A Memorandum of

Understanding (MOU) is simply a written agreement between parties to

identify the working relationships and guidelines obligatory to each other. It

expresses a convergence of will between the parties, indicating an intended

common line of action being spelt the common understanding fulfilling the

ultimate objective. It clarifies what kind of support will be provided and

outlines specifics of communication and duration. It defines the rights and

responsibilities of each involved entity.

5. Volunteer Management Kits: Volunteers play important roles during an

emergency disaster response program. In order to safeguard the interest of the

volunteers and the organization engaging volunteers to achieve main

objectives, we have the following procedures to be followed strictly.

a) Volunteer Requisition Form – A formal written request by the host

organization to the individual or partners of volunteer needed for the

specific event. It generally includes brief description on event, number of

volunteer required, duration and task.

b) Volunteer Application Form – Volunteer Application form seeks basic

personal information of the applicant, its profession and commitment to

participate in any humanitarian emergency response program. One has to

fill VA form to register themselves as EHA's volunteer.

c) Know Your Volunteer – KYV is a single page form to help us know

more about the volunteer's personal details, hobbies, skills, area of

interest and in case of emergency contact.

d) Volunteer Codes of Conduct – Volunteer codes of conduct are

imperative for discerning acceptable and unacceptable workplace

behaviors and organization's practices. This is to ensure volunteer

operates professionally and ethically.

e) Volunteer Pledge – A solemn promise or agreement to do or refrain

from doing something. Its an undertaking, word of honor for the

particular event.

f) Volunteer Identity Card: Identity card is issued to all the registered

volunteers as part of the safety measures and relief protocol.

6. NGO Code of Conduct - EHA is a signatory of the code of conduct for the

International Red Cross and Red Crescent Movement and comply with the

Humanitarian Charter and Minimum Standards in Humanitarian Response.

The code of conduct was drawn up for Humanitarian Response to set ethical

standards for organizations involved in humanitarian work.



7. Procurement Protocol – Procurement protocol should be followed to deliver

efficient services and good quality relief materials for the disaster affected

people on time. On the basis of general and item specific materials, potential

suppliers are evaluated by the procurement committee in term of quality,

pricing, availability and time. Then being followed by a well organized

procurement order.

a) Prescribed formats - purchase order, standard quotation etc.

b) Quality Control – The basic goal of this process is to ensure that the

products or services provided meet specified standards of quality and

characteristics. Most often, it involves thoroughly examining and testing

the quality of products chosen randomly. The quality control team is to

make sure those products and services meet the specified standards of

quality. If a problem is identified, the job of a quality control team might

involve stopping the product or service until the problem has been

corrected or replaced.

c) Purchase Committee – The role of purchase committee is to see the

overall (transparency and democratic) process of procurement and

transportation of the relief materials. It includes identification of

suppliers, collection of quotations, comparing of quotations, quality

checks, prioritization of materials as per quality, availability and rates,

collection of sample kits, tender documents, placement of order,

inspection of materials and payment etc.

8. Relief Organogram: A hierarchical Relief Management Organogram shows

the line of authority and line of control with important roles each position

plays for effective management of relief program. This is to ensure

transparency, responsibility, accountability and efficiency. Disaster response

is a team initiative and maximizing local participation ensures smooth and

effective relief program. The formation of teams also ensures line of

authority in tune with the best practiced Incident Response System. Based on

the best practices learning during the decades of experiences, we recommend

the following important team formation for transparent and effective results –

a) Emergency Relief Committee (ERC) at the organizational level: The

Emergency Relief Committee consists of Executive Director, Finance

Director, Regional Director (relevant), Central Coordinator, DMMU &

Project Manager- Emergency response, DMMU of EHA. The primary

responsibility of ERC is to ensure adequate and effective response. Their

role is one of initial response planning, establishing management system

for implementation of an adequate response, to facilitate a better and

effective emergency relief program. The ERC is the final decision

making body in terms of financial matter, program implementation and



have ultimate responsibility of directing the activity ensuring well run

and delivering the outcome for which it has been set up.

b) Core Relief Team (CRT) – The CRT is formed to facilitate the overall

functioning of the response program in the field ensuring inclusion of

maximum local participation which includes, leaders of the community,

partner representative, representative from various groups in the

community (women, disability) and from responding organization. The

CRT monitors and coordinates the overall implementation plan and

closely works with the community and volunteers. The CRT is headed by

the Chairperson who is selected by the members.

c) Village Relief Committee (VRC) – The VRC is formed within the

respective village of all beneficiary villages. Each village will have their

own VRC. The committee includes panchayat head/member, village

head, ASHA/Aw workers, FBOs leaders, women, youth and special

group representative etc. The committee will assist in conducting

beneficiary survey, identification of distribution location, distribution

process, crowd management, maintaining of record etc.

9. Kits – There are kits which secure minimum safety, security and care for

volunteers. The best way to stay safe during responding to any emergency is

to have an emergency safety kits in place.

Volunteer Safety Kit – Volunteer safety kit include both personal and

general basic safety kits.

First Aid Kit – First aid kit includes basic requirement for immediate

treatment of injuries, fracture, bleeding etc.

General kit- The emergency general kits includes the basic items

required during responding to any emergency.

10. Volunteer checklist – The checklist is a step by step instruction for

registering volunteers during emergency response. This procedure would

ensure clarity of role and safety of volunteers while documenting essential

information to provide safeguard from undue eventualities.



Initial Assessment Form (within 24 hours)

1 What disaster: Tick the right one

Type: Earthquake/Floods/Fire/Cyclone/Building collapse/others- Intensity: Very high/High/Medium/Low.

2 Time & Date:

3 Where? Exact location: Total number of Villages/Towns affected- Names of the most affected villages-

4 Extent of visible impact by: Mention reported statistics against each-

Injured- Missing- Displaced- Death (reported)- Damages in Rs.

5 Possible immediate needs:

Medical- Drinking water- Food- Shelter-

Rescue- Psycho-social care- Disability- Others-

6 Infrastructure damaged: If yes, give statistics as far as feasible-

Houses- Hospitals/Health Centers- School/College- Government offices- Road- Railway track- Airport- Bridge-

Water supply- Electricity- Telecommunications- Dam- Cold storage- Go-downs (FCI)- Others-

7 Visible help arrived from: Please mention what help is made available-

Government agencies- NDRF- NGOs/INGOs- Clubs-

FBOs- CSOs- Others-

8 Important contacts (Name & Numbers):

District Collector- Emergency Officer in charge- Superintendent of Police- Sub Divisional Officer- Block Development Officer- Police officer in charge-

Fire Department- Panchayat leader- IAG coordinator- Local contact- Local contact- Local contact-

9 Source of information: Direct observation- If over phone (name & contact number please)- TV/Radio- Local news paper-

10 Informant's name:

11 Informant's contact number: Mobile- Mobile (second option)- Alternate number- Address/Institution-

12 Some descriptions of the incident:

13 Date & Time you are reporting:

14 Signature of the informant:



Rapid Spot Assessment Form

1. Disaster Type: Date of Disaster event: Time:

Date of Assessment: Time:

2. Affected Village: Block: District:

Category (Tick) Worst affected Moderately Affected Least Affected

3. Demography:

Population House Hold SC/ST/Minorities Injured Missing Death

Total

Affected

Human loss 0 – 1 yrs 2 – 14 yrs 15 – 60 yrs 61 yrs &

above Disabled

Total M: F: M: F: M: F: M: F: M: F: M: F:

Disability data Physical

impairment Sensory

impairment Intellectual impairment

Mental impairment

Total

Age 0 – 5 yrs

Age 6 – 15 yrs

Age 16- 30 yrs

Age 30 – 55 yrs

Age 56 & above

TOTAL

4. Infrastructure: Service Status before disaster

(partially/fully damaged) Status after disaster

(partially/fully damaged)

Health Center

Hospital

Water supply (drinking)



Road

Rail

Air

Bridge

School

Panchayat office

Community Center

Tele communication

Power supply

Public Distribution System

Emergency shelter

5. Shelter: Total no. of houses: Fully damaged: Partially damaged:

6. Livelihood:

Loss of agricultural

crop

Damage of agricultural

field

Fodder availability

Livestock lost

Affect on small scale

businesses

Affect on large businesses

(shop/market etc.)

% % % # @ @

7. Health & Hygiene: No. of Hospital/s or

Clinics:

Possible outbreak of diseases?

Management of corpses,

carcasses or debris

Emergency medical facilities

Emergency healthcare

professionals

Emergency medical supplies

Any history of post disaster

epidemic

Reasons if yes: Water borne?

Who, if yes: Municipal?

What, if yes:

How many and who, if yes:

For how many days, if yes:

When and what, if yes:

Hygiene need



8. Education: Pre-Primary High school Pre-College Total

Infrastructure damage

Damage of materials

9. Water & Sanitation:

Availability of sources of

water supply

Condition of drinking water

supply

Accessibility of water

Quality of water

Distance from

defecation sites

Condition of existing toilets

Damage & status of drainage system

10. Food & Nutrition:

Dry food available in domestic

level

Cooking facilities & utensils

Food stock in PDS for # days

Need for community

kitchen

Space for kitchen

Nutritional requirements

# days Sufficient/Insufficient # days High/Medium/Low Available/Not available

Yes/No

11. Clothing:

12. Social security:

Any report of loots,

hoardings and sudden

price rise

Statements by local government officials/disaster

management authorities/politicians on

prevalent security situation

Past history of any religion/caste/class

based biases

Any adverse news in local

newspapers/TV and/or radio

Safe access to relief

materials

Explain briefly:

Briefly state: Briefly state: Briefly state: Yes/No. If no, why?



13. Ongoing response program

Sectors Local Govt.

Qtty/ Days

Local CBOs

Qtty/ Days

NGOs/ INGOs

Qtty/ Days

Others: Defense

etc.

Qtty/ Days

Food (specify)

Nutrition

Water

Sanitation

Temporary shelter

Clothing/Dignity kit

School kits

Health

Hygiene

Kitchen utensils

Winter kits

Fodders

14. Source of information:

Local leaders FBO leader

Local individual Teacher

SHG member Local NGO/Club

Women group Anganwadi worker

Youth group ASHA

PRI member Member- VDMC

Persons With Disability representative Eye witnesses

Block official Other



15: Contact numbers of Key Contacts:

1) Panchayat President 6) DC – Control Room office

2) VDMC member 7) Police Station i/c

3) FBO leader 8) ASHA

4) Block Development Officer

9)

5) Sub-Divisional Officer 10)

16. Unmet needs: 1) 2) 3)

17. Rapid Spot Assessment Team:

Full name Special area Mobile Signature

Submitted by Emergency Relief Officer Date: Place:

(This report should be sent within an hour of completion.) Copies to: Central Coordinator, DMMU-EHA, Delhi. Project Manager- Emergency Response &Documentation, DMMU-EHA, Delhi. Executive Director, EHA.



Emergency Relief Team Formation

1. Rapid Assessment Team (RAT)

Sl Name Existing position

Skills Designation Contact Signature

1 CC, DMMU ER Specialist, Assessment.

Chairman

2 PM-ER, DMMU ER Specialist, Quality.

Member.

3 ERO, DMMU ER Specialist, Rescue & Logistics.

Member.

4 Sectoral expert Medical, WATSAN, Food & Nutrition, Psycho-social

Member

5 Sectoral expert Quality, PWD, gender etc.

Member.

Note: The team should consist of 2 female representatives.

2. Emergency Relief Committee (ERC), Delhi

Sl Name Existing position Designation Contact Signature

1 Executive Director. Chairman

2 Finance Director. Member.

3 Regional Director/ Representative, designated by ED

Member.

4 Central Coordinator,DMMU Secretary

5 Project Manager, Emergency Response, DMMU.

Member.

Note: The committee should consist of 2 female representatives.

3. Core Relief Team (CRT)

Sl Name Desired representation Designation Contact Signature

Community Leader of repute. Chairperson

Local partner/Unit Vice-Chair

Local community rep Member



Local community rep Member

Rep from special group Member

Emergency Relief Officer Coordinator

DMMU, HQ Ex-officio

Note: The Core Relief Team should consist of 3 female representatives.

4. Village Relief Committee (VRC)

Sl Name Desired representation Designation Contact Signature

President Gram Panchayat

Chairperson

Village Headman Vice-Chair

ASHA Worker Member

Any other groups/ FBO/ AW etc

Member

Special groups rep Member

Local representative Member

Emergency Relief Officer

Coordinator

5. Purchase Committee:

Sl Name Existing position Designation Contact Signature

Emergency Relief Officer

Chairman.

Local partner/Unit Member

Local rep with knowledge & experience in purchases

Member

Finance person from local Unit

Member

DMMU, HQ Ex-officio

ED, HQ Ex-officio

FD, HQ Ex-officio



Household (beneficiary) Survey

1 Name: Family

Head:

Name of the Responder:

2 Family

statistics 0-1yrs Above 1-

18yrs Above 18 -

60yrs Above 60yrs Total

Male

Female

Sub-total

Missing

Death

3 Any Pregnant women Yes/No Term:

4 Any Lactating mother Yes/No Age of breastfed child:

5 Any persons with disability

Yes/No Type:

6 Caste:

7 Income

Source of Income Loss, if any

Monthly Income in Rs.

Tick

Labor Below 1000

Farming 1001 - 3000

Business 3001 - 5000

Salaried Above 5000

Any other?

Total earning members



8 Shelter Type of house Roofing

Bamboo Mud & Bamboo

Bricks Thatched

Tiles Tin sheets Concrete

Own

Others

Damage Complete Partial None

9 Water & Sanitation

Source of drinking water

Hand pump (own)

Hand pump (community)

Pond Others Toilet

Yes/No

Damage, if any

10 Other damages or losses

Quantity Estimated amount

Livestock

Moveable assets

Documents

11 Health Chronic

illness Illness developed due to disaster Any injuries

Specify

12. Remarks:

Full name of the Surveyor: ID # : Signature & Date: Survey location:



Volunteer Application Form

Sl.# I,………………...................................... agree to volunteer in Emmanuel Hospital Association's humanitarian emergency response programs in India and/or countries it offers. I agree to abide by the EHA volunteer Code of Conduct and Protocols and hence submit the following information.

Section A: PERSONAL DETAILS

1. Full name in Capital: Gender: M/F

2. Date of birth (dd/mm/yy):

3. Address:

Location: District: State: Pin code: Mobile #: E-mail ID:

4. Other information: (provide copy)

Driving License #: Passport#: Date of Expiry:

Insurance #: Date of renewal:

Student or Employment ID#:

Section B: PROFESSIONAL

5. Profession: Student/Service/Other- 6. Educational background: 7. Name of the person recommended, if any: 8. Did you sign up with any other organization as volunteer? If Yes, please mention- 9. Please write in a paragraph (additional paper) as to why would you like to volunteer EHA's

humanitarian response programs- 10. Are you willing to attend volunteer training program? Y/N. 11. Disability- Y/N. If Yes, type of disability and disability access requirement- Applicant's Signature Date:

------------------------------------------------------------------------------------------------------------------------------------------ Office purpose

1 Volunteer Pledge signed up and accepted as volunteer.

2 Entered in V-Dbase.

3 Linked with regional DRN.

4 Training provided in BDR/FA/BLS/ACLS/FS/S$R/LS/PSC.

5 Volunteer kits provided: T-shirt/Cap/Volunteer Guide/any other-

Signature of the Evaluator: Date:

PS. Eligibility age: 18 & above. Applicants under 18 years require written parental consent.

Stamp size

current

photograph

Pp size

photograph



Volunteer Pledge

By signing this pledge I, …......................................................................................... as volunteer of Emmanuel Hospital Association (EHA) Disaster Management & Mitigation Unit, agree with the followings- Follow the Code of Conduct, Safety Procedures and Instructions. Shall conduct myself in an appropriate manner, to dress in attire that is conducive to the local community. Help victims to the best of my ability in a systematic manner with scarce resources made available for the purposes only. Promote values and principles of just, fair & equality irrespective of caste, religion, gender, age, language, ability and economic background, without any discrimination. Implement assignments provided to me to the best of my knowledge and capacity, for achieving the objectives within given time frame. Shall not disclose any confidential information, photographs or any other document etc. obtained during the course of the assignment. I recognize the inherent risk of physical injury that could result from traveling to and from this program or participating in this project; Hence, while performing as a volunteer, I, hereby waive any legal claims of liability of damage suits against EHA and its designated staff, or its partner agencies, either by me or my family. I promise not to engage in any activity that may cause harm to others or myself or disrupt the effective functioning of the event. I affirm that my health is good, and that I am not under any physician's care for any undisclosed condition that might endanger my health or the health of other participants. I understand that this is a public event and I may be photographed by the media and/or by the organization for future print and/or any kind of publications. I understand that failing to observe the above pledges will result in my dismissal from the volunteer event. Full name of the Volunteer: Place: Signature of the Volunteer: Date:



Know Your Volunteer (KYV)

1. Personal Information: a. Full Name: Gender: M/F Marital Status: Age: Language Known: Hobbies: Health status (Indicate if any): In Case of Emergency contact #s: 1. 2. 3. b. Current Address:

House #: Lane Number: Village/Town/City: District: State : Pin code:

c. Training & Skills in : Occupation: d. Name & Address of Employer: e. Telephone:

Home: Mobile: Business/Office: Fax: E-mail Address:

f. Have you ever been convicted, or had adjudication withheld in a criminal offense, misdemeanor or are there any criminal charges now pending against you other than a minor traffic violation? Yes _________ No _________ If Yes, Please provide a brief explanation on a separate sheet of paper. 2. Volunteer category: (Tick where you want to be) a. General b. Task Force C. Medical d. Psycho-social 3. Experience: a. Have you ever volunteered for any emergency response or other voluntary activities before? If yes;

Event When Location Organization In what capacity



4. Your area of interests (specify for this event): 5. Declaration:

Self declaration & Undertaking: I understand that I am offering my services to the Emmanuel Hospital Association on voluntary basis towards its humanitarian relief action. I agree, as a volunteer, to abide by prevalent EHA rules, regulations, policies and practices, either published or in effect by usage. I also recognize the inherent risk of physical injury that could result from participating and performing the activities/tasks allocated to me in this project. Signature of volunteer applicant: Date:

Signature of the Base Office Volunteer i/c : Date:



Volunteer Checklist

Volunteer Check-list

1 Application Form & Sign up of Pledge

2 Sign up Agreement on Reporting to the Field Office (EOC)

3 Know Your Volunteer (KYV)

4 Event Registration Process

5 Orientation- Mission, Vision of the Org/about the event/Code of Conduct/Safety/Admin issues

6 Job Card

7 Photo Identity Card (PIC)

8 Volunteer kits- Personal (Water bottle/Winter Jkt/T-Shirt/Cap etc.) & Safety (returnable) Gears (Life Jacket/Flash light/pair of Boots/Raincoat/Mobile phones etc.*)

9 Insurance

10 Admin- logistics/allowances/tickets/acknowledgment etc.

* Please strike out, whichever is not application in this case







Internal Decision Making Process In case of disaster event affecting EHA Unit

Disaster occurs

4-8

hrs

24

hrs

72

hrs

First information to

ED/DMMU

Initial Assessment

(can be done over

phone) by local

Unit. DMMU

develop based on IA

SitRep-1

Communicate to ED

for a Decision

Respond Do not Respond Wait

Mobilize RAT

Draw Action

Plan

Mobilize

Resource

Mobilize Team

Review

SitRep



Decision Tree for Emergency Response

Built-in program Event based

Exte

rnal

inp

uts

24

ho

urs

8 h

ou

rs

Exte

rnal

inp

uts

24

ho

urs

(b

ased

on

tra

ined

loca

l Res

po

nse

Tea

m a

vaila

ble

)

72

ho

urs

72

ho

urs

ED= Executive Director of EHA Sit-Rep= Situation Report

IC= Incident Command EOC= Emergency Operations Center

ER= Emergency Response EHA= Emmanuel Hospital Association

ERC= Emergency Relief Committee IAP= Initial Action Plan

RAT= Rapid spots Assessment Team

Note: The decision tree corresponds with the Flow Chart.

Internal decision making processes

Closely watching early

warning for seasonal &

natural disasters

Disaster occurred

Emergency Team establish linkages with

local contacts & begins validation

processes.

Information from disaster

spot (Response

Center/EHA Unit)

Disaster occurred

Initial assessment

Communicate with ED/IC for probable ER

Initial assessment

Build up SitRep with

constant updates.

Alert RAT and specialized volunteers

Build up SitRep with

constant updates.

Analysis of initial reports &

draw an IAP

Float IAP for mobilizing resources,

intimate ERC and mobilize

RAT

Call to Action/Team

arrival

Feed RAT information to

build Emergency Response Program

Call to Action/Team

arrival

EOC activated in

full scale

EOC activated in

full scale

Date post:	16-Jul-2018
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