Forms • Story County, IA • CivicEngage

Status Report Form-Internal Operations

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NAME OF OFFICE/DEPARTMENT *
Time Period for Reporting
IS THE INFORMATION SUBMITTED IN THIS REPORT THE SAME AS THE PREVIOUS REPORTING PERIOD? IF YES, YOU ONLY NEED TO ANSWER THIS PART AND SUBMIT. YOU DO NOT HAVE TO DO ANYTHING ON THIS FORM OTHER THAN SCROLLING TO THE BOTTOM AND HIT SUBMIT.
CLICK YES IF THERE ARE NO CHANGES YES
Damage Assessment Information: Provide a summary of current negative impacts on operations. Provide a summary of anticipated negative impacts on operations for the next 24 hours. Provide list of equipment or facilities damaged or disabled.
Status of Staff
# of staff:
# of staff currently on duty:
# of on duty staff injured:
# of on duty staff deceased:
# of on duty staff unaccounted for:
# of available off duty staff:
# of off duty staff not available:
# of off duty staff not accounted for:
# of non-essential employees sent home
# of essential employees sent home
# of essential employees working in the work place
Essential Functions: List essential functions negatively impacted from the following categories as listed in the COOP/COG plan: 7 to 30 days.
Items for Escalation
Office/Department Strategic Objectives/Priorities and Actions
Priority 1
Priority 2
Priority 3
Priority 4
Priority 5
Priority
Resources Committed
Resource Committed 1
Resource Committed 2
Resource Committed 3
Resource Committed 4
Resource Committed 5
Resource Committed
Resources Requested
Resource Requested 1
Resource Requested 2
Resource Requested 3
Resource Requested 4
Resource Requested 5
Resource Requested
Top 5 Risks and Issues
Risk/Issue Severity Action Owner
Budget Impacts
Comments

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