Capability Assessment

Medical Reserve Corps (MARC) Unit Profile and Reports

990-0302 Tool 2_Capabilities Assessment

Capability Assessment

OMB: 0990-0302

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Capabilities Assessment

Form Approved

OMB No. 0990-0302

Exp. Date XX/XX/20XX



Instructions: There are no right or wrong answers. The purpose of this worksheet is to identify your MRC unit’s capabilities.


We encourage you to share information on your unit’s capabilities with your community partners so that your MRC unit may be properly utilized.


Please use the “Comments” section to expand on or clarify your answers for each capability, as necessary.


Capabilities


Incident Response Support

Public Health and Medical Information Management

Crisis and Risk Communication

Emergency Operations Center Support

Family Assistance Center Support

General Shelter Staffing (non-medical/non-environmental)

Multi-Agency Resource Center (MARC) Support

Volunteer Reception Center Support

Social Media Monitoring and Messaging


Medical Countermeasure Dispensing

Mass Vaccination

Mass Prophylaxis


Behavioral Health

Disaster Behavioral Health - Responders

Disaster Behavioral Health – Community Members

Suicide Prevention/Response






According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0302. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, to review and complete the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer




Epidemiology

Surveillance Support

Community Assessment

Outbreak Investigation

Disease Detection


Environmental Health

Vector Control

Environmental Contamination - Chemical

Environmental Contamination – Biological

Environmental Contamination – Radiological

Radiological Community Reception Centers/Population Monitoring

Environmental Contamination – Hazardous Materials

Food Safety

Water Quality


Animal and Veterinary Care

Companion Animal Care and Sheltering

Companion Animal Veterinary Care and Treatment

Large Animal Veterinary Care and Treatment


Medical Care

Occupational Health

Hospital Alternate Care Sites

Medical Surge

Shelter Support/Medical Care

Medical/First Aid Staffing (e.g. special events, firefighter rehab)

Disease Screening

Infectious Disease Testing or Treatment

Other/Specialties

Local Community Need Campaign Development (e.g. Opiate Crisis Response)

Fatality Management and Victim Identification

Other


  1. Question:


Please select the most appropriate answer from the drop-down menu to indicate the degree to which your MRC unit possesses a capability or conducts an activity. Please note: If your answer to this question is “No”, you do not need to answer question 2 through 8 for the applicable capability or activity.


Is this capability part of your MRC unit’s mission?


Answer:

Yes and is a part of our MRC mission statement

Yes but it is not a part of our MRC mission statement

No


  1. Question:


Please select the most appropriate answer from the drop-down menu to indicate, in general or on average, the highest level of training in a capability achieved by your MRC members or specialized team. If “Classroom Training” is selected, please indicate the training course completed in the “Comments” section.


What is the highest level of training in this capability achieved by your MRC members or specialized team?


Answer:

N/A

No training

Classroom/On-line training

Notification drill/call-down exercise

Online simulation/virtual exercise

Tabletop (internal)

Tabletop (with external partners)

Functional (internal)

Functional (with external partners)

Full-scale


  1. Question:


Please select the most appropriate answer from the drop-down menu.


Has your MRC unit participated in a NON-EMERGENCY event involving this capability?


Answer:

Yes

No



  1. Question:


Please select the most appropriate answer from the drop-down menu.


Has your MRC unit participated in an EMERGENCY incident involving this capability?


Answer:

Yes (Standby Only)

Yes (within jurisdiction)

Yes (outside jurisdiction)

Yes (within and outside jurisdiction)

No


  1. Question:


Please select the most appropriate answer from the drop-down menu to indicate how long it will take your MRC unit to get ready to provide a capability.


In general, how much time is required for your MRC unit to mobilize in order to provide this capability with no alert or prior notice?


Answer:

Unknown

< 3 hours

3 - 6 hours

6 – 12 hours

12 - 18 hours

18 – 24 hours

1 – 2 days

2 – 3 days

4 – 5 days


  1. Question:


Please select the most appropriate answer from the drop-down menu to indicate the period of time that your MRC unit can be used to provide a capability.


In general, how long is your MRC unit able to provide this capability in your community?


Answer:

< 8 hours

8 – 24 hours

24 – 48 hours

48 – 72 hours

72 hours – 1 week

1 – 2 weeks

More than 2 weeks

Unknown




  1. Question:


Please select the most appropriate answer from the drop-down menu to indicate the amount of supplies and equipment your MRC unit has to provide a capability.


If activated, does your MRC unit have the supplies and equipment necessary to perform this capability?


Answer:

Yes (have all necessary supplies and equipment)

Yes (have some supplies and equipment)

No (must use supplies and equipment from others)



  1. Question:


Please select the most appropriate answer from the drop-down menu to indicate if your MRC unit has a standardized response package or related to this capability. A standardized response package is a specific response and recovery resource capability that is organized, developed, trained and exercised prior to an emergency or disaster. MRC Unit Coordinators can develop standardized response packages based on their local community response needs and the volunteer capabilities within their unit. These standardized response packages can be used as a vehicle to train and develop teams for specific response roles and missions.


Can your MRC unit provide this capability in the form of a standardized response package?


Answer:


Yes

No

No (but intend to develop)


Comments: (Free Text Box)




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