Please use this report to evaluate your emergency event activities, and emergency planning.  A one year exemption from Community Emergency Drill will be granted after the completed AAR has been reviewed and accepted by the Network Emergency Manager and State Department of Health.

The purpose of this After Action Report (AAR) is to analyze the event, document results, identify strengths, identify potential areas for further improvement, and support development of corrective actions as follows:

Identify issues resulting from the event
Identify the entities involved and the activities (Meetings) they performed – before, during and after the emergency,
Identify areas of strength regarding the performance of the facility staff,
Identify areas of weakness regarding the performance of the facility staff,
Identify opportunities for quality improvement for facility Emergency Preparedness
Conclusion

Your Name, Facility and Title

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* 1. Your Name, Facility and Title

Facility CCN # (#xx-XXXX)

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* 2. Facility CCN # (#xx-XXXX)

Please list:

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* 3. Please list:

Event Type

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* 4. Event Type

Please List Incident Date(s)

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* 5. Please List Incident Date(s)

Did staff utilize the Facility Emergency Plan?

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* 6. Did staff utilize the Facility Emergency Plan?

Please describe the impact on patient population (no PHI) Please use whole numbers i.e. # of missed treatments, # sent to ER, #rescheduled, # sent to backup facility.

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* 7. Please describe the impact on patient population (no PHI) Please use whole numbers i.e. # of missed treatments, # sent to ER, #rescheduled, # sent to backup facility.

Event Overview
Description of issues/barriers to care resulting from the event (e.g. communication issues, transportation issues, patient issues) [can be a list of issues or “no Issues/Barriers Identified”]

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* 8. Description of issues/barriers to care resulting from the event (e.g. communication issues, transportation issues, patient issues) [can be a list of issues or “no Issues/Barriers Identified”]

Entities Involved in the Emergency:
(the organizations and stakeholders that were involved in managing event response)

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* 9. Entities Involved in the Emergency:
(the organizations and stakeholders that were involved in managing event response)

Meeting and Calls (please list event related meetings and calls)

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* 10. Meeting and Calls (please list event related meetings and calls)

Hotwash/After Action Staff Meeting (Please list date and highlights of post event meeting to discuss emergency activities and improvements)

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* 11. Hotwash/After Action Staff Meeting (Please list date and highlights of post event meeting to discuss emergency activities and improvements)

Self Analysis: Describe briefly the strengths and challenges discovered during the incident
The two major strengths identified during this event are as follows:

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* 12. The two major strengths identified during this event are as follows:

The two major challenges identified during this event are as follows:

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* 13. The two major challenges identified during this event are as follows:

Conclusion: Describe the resolution. Briefly describe the lessons learned and the improvements to be developed, which tie into the body of this report and the updating Emergency Planning/Training and or your Improvement Plan (IP).

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* 14. Conclusion: Describe the resolution. Briefly describe the lessons learned and the improvements to be developed, which tie into the body of this report and the updating Emergency Planning/Training and or your Improvement Plan (IP).

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