(Please return on Hospital Letterhead)
TO:HHSHospital Preparedness Program
FROM:POC
Hospital Name
Hospital Address
DATE:October 30, 2009
SUBJECT:NIMS Compliance
To Whom It May Concern:
I am writing thisletter on behalf of(Insert Name of Hospital)to self certifythat the following 14National Incident Management System (NIMS) Implementation activitieswere completed in accordance with the Health and Human Services (HHS) Hospital Preparedness Program by September 30, 2009.
Element 1 - Adopted NIMS throughout the healthcare organization including all appropriate departments and business units.
Element 2 - Ensured Federal Preparedness awards support NIMS Implementation (in accordance with the eligibility and allowable uses of the awards).
Element 3 - Revised and updated emergency operations plans (EOPs), standard operating procedures (SOPs), and standard operating guidelines (SOGs) to incorporate NIMS and National Response Framework (NRF) components, principles and policies, to include planning, training, response, exercises, equipment, evaluation, and corrective actions.
Element 4 - Participated in interagency mutual aid and/or assistance agreements, to include agreements with public and private sector and nongovernmental organizations.
Element 5 - Identified the appropriate personnel to complete ICS-100, ICS-200, and IS-700, or equivalent courses.
Element 6 - Identified the appropriate personnel to complete IS-800 or an equivalent course.
Element 7 - Promoted NIMS concepts and principles into all organization-related training and exercises. Demonstrate the use of NIMS principles and ICS Management structure in training and exercises.
Element 8 - Promoted and ensured that equipment, communication, and data interoperability are incorporated into the healthcare organization’s acquisition programs.
Element 9 - Applied common and consistent terminology as promoted in NIMS, including the establishment of plain language communications standards.
Element 10 - Utilized systems, tools, and processes that facilitate the collection and distribution of consistent and accurate information during an incident or event.
Element 11- Managed all emergency incidents, exercises, and preplanned (recurring/special) events in accordance with ICS organizational structures, doctrine, and procedures, as defined in NIMS.
Element 12- Incorporated the consistent application of Incident Action Planning (IAP) and common communications plans, as appropriate.
Element 13 - Adopted the principle of Public Information, facilitated by the use of the Joint Information System (JIS) and Joint Information Center (JIC) during an incident or event.
Element 14 - Ensured that Public Information procedures and processes gather, verify, coordinate, and disseminate information during an incident or event.
In addition, I certify that my hospital has a plan in place to provide the appropriate training to any new staff members.
Please know that all documentation to support this claim is in place and will be provided upon request. Should you need additional information, please feel free to contact please contact (Insert Name and contact), Insert Title) at (Insert phone and email information here).
Sincerely,
Name of CEO
Title
Hospital Name