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Healthcare Surge: Facility Damage Report (Limited Assessment) Mobile App

It is recommended that facilities should create plans that guide decision making around operating or abandoning a degraded environment. Facilities should develop a list of “fatal deficiencies/flaws” that would trigger immediate evacuation using the Healthcare Surge: Facility Damage Report (Limited Assessment) mobile app. Plans should identify an organizational person to perform an immediate assessment. GoCanvas allows you to capture signatures, insert photos, capture GPS coordinates, dispatch technicians to jobs, conduct calculations and utilize common form fields like drop-downs, checkboxes, text boxes, and more.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Healthcare Surge: Facility Damage Report (Limited Assessment) Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

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    Description

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    It is recommended that facilities should create plans that guide decision making around operating...

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    A high-level assessment of the facility should be conducted to ensure that the facility has maint...

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    Capability of providing essential patient care (routine care as well as management of injuries or...

  • Ico checkbox

    Integrity of structure is in intact with no obvious damage and availability of access to all areas

  • Ico checkbox

    Availability of essential services such as power, water, gas and communications

  • Ico checkbox

    Availability of adequate staff, supplies and equipment for the next 72 hours (e.

  • Ico checkbox

    Ability to function without assistance for the next 72 hours

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    Instructions

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    Complete the facility damage report to assess structural integrity of your facility during a cata...

  • Ico textbox

    Facility Name &Type

  • Ico multiline

    Address

  • Ico date

    Date

  • Ico time

    Time Report Given

  • Ico textbox

    Census

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    Contact Person

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    Title

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    Location

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    Preferred Contact Method

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    Preferred Contact Number

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    Complete the worksheet through interview or fax to facility completion and return ASAP.

  • Ico dropdown

    Can you provide essential patient care?

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    Is your facility intact?

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    Are essential services intact?

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    And equipment for the next 72 hours?

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    hours?

  • Ico multiline

    Comments:

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    If the answer to any question is “partial” or “no,” the Licensing and Certification District Offi...

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