Staff Notification and Assembly Drill

Form Approved

OMB Approval No. 0920-xxxx

Expiration Date: xx/xx/xxxx

Staff Notification and Assembly Drill

Drill information

a. Date and time first person notified

b. Date and time last person acknowledged notification

c. Extent of advanced notification (full, partial, none)

d. Incident management roles (or equivalent lead roles) activated (Select all that apply)

e. Target time for assembly (in minutes)

f. Type of staff assembly (call down only – no assembly, physical, virtual, both)

g. Date/time last person assembled

h. Total number of staff who assembled

i. Total number of staff who assembled within target time period

Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).