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Form 1 - HEARS Field Report
Form 1 - HEARS Field Report
Department of Health
REGIONAL OFFICE IV-A
HEALTH EMERGENCY MANAGEMENT STAFF
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline No.: 990.4067 to 74 local 119, 120, 122/ Direct line: 440.3551/ 440.3372
Telefax: 913.3616
E-Mail Add.: chd4a_doh_calabarzon@yahoo.com
hemsopcen.calabarzon@gmail.com
(Upon learning about the occurrence of an event, the HEMS Coordinator shall immediately inform the DOH-HEMS Operation Center through the
fastest communication means available. Then this Form 1 shall be filled-out and sent ASAP or within 24 hours upon occurrence of the event.)
A. Event Information
Type of Event: GEOLOGIC WEATHER BIOLOGIC MAN-MADE
Volcanic Eruption Typhoon Red Tide Epidemic Poisoning, specify ______________
Earthquake Storm Surge Fish Kills Fire Mass Action, specify____________
Tsunami Drought Locust Explosion Accident, specify ______________
Landslide Cold Spell Infestation Armed Conflict Other, specify_________________
Lahar Flashflood Terrorism
Date of Time of AM Exact Location:
Occurrence: Occurrence: PM Region: Province: Municipality/City: