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
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
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
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
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
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
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
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)
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)
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Microsoft Office User |
| File Modified | 0000-00-00 |
| File Created | 2023-09-05 |