Hospital Status Report|F!303

# Form updated 02/24/2023. This is a default JS8Spotter MCForms form. See kf7mix.com for details.

? Reporting for which hospital?
@1 Closest to operator QTH
@2 Specific hospital, see comments

? Overall ability to provide essential care services:
@1 Normal
@2 Modified partially functional - no assistance needed
@3 Limited partially functional- Some assistance needed
@4 Impaired - major assistance needed
@5 Not functional - major assistance needed
@6 Status unknown

? Hospital COMMUNICATION: Internet?
@1 Yes
@2 No
@3 Partial or intermittent
@4 Unknown

? Hospital COMMUNICATION: Landline Phone and/or Cell/Text?
@1 Yes, landline and cell/text
@2 Yes landline, no cell/text
@3 Yes cell/text, no landline
@4 Yes text, no cell phone or landline
@5 Partial or intermittent landline, no cell
@6 Partial or intermittent cell/text service, no landline
@7 Partial or intermittent landline, cell and text
@8 Unknown

? Hospital COMMUNICATION: Amateur Radio and/or Satellite Phone?
@1 Yes, amateur radio and satellite phone
@2 Yes amateur radio, no satellite phone
@3 Yes satellite phone, no amateur radio
@4 Partial or intermittent amateur radio and satellite phone
@5 Partial or intermittent amateur radio, no satellite phone
@6 Partial or intermittent satellite phone, no amateur radio
@7 Unknown

? Hospital UTILITIES: Power?
@1 Yes full, municipal source
@2 Yes full, generators
@3 Partial power, generators
@2 No power
@3 Unknown

? Hospital UTILITIES: Water?
@1 Yes full, municipal source
@2 Yes full, reserves
@3 Partial water, reserves
@2 No water
@3 Unknown

? Hospital UTILITIES: HVAC?
@1 Fully operational
@2 Patial operation
@2 None
@3 Unknown

? Evacuations (select highest accurate level)?
@1 None currently planned
@2 Partial evacuation planned
@3 Partial evacuation in process
@4 Partial evacuation completed
@5 Full evacuation planned
@6 Full evacuation in process
@7 Full evacuation completed
@8 Sheltering in place
@9 Unknown

? Casualties and/or injuries?
@1 No injuries, no deaths
@2 Minor injuries, no deaths
@3 Significant injuries, no deaths
@4 Significant injuries, 0-3 deaths
@5 Major injuries, 0-5 deaths
@6 Heavy injuries, probable or confirmed deaths
@7 Many heavy injuries, confirmed deaths

