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EMERGENCY PREPAREDNESS TEMPLATE - New Hampshire …

Health Facilities Administration-Licensing 6/11/2015 Page 1 EMERGENCY PREPAREDNESS TEMPLATE *This TEMPLATE is designed to help facilities keep track of EMERGENCY PREPAREDNESS information. The fields can be typed in online or the form can be printed out and done by hand. To save the information, print when done filling out, then do a save as and rename document. FACILITY: LICENSE #: DATE OF ORIGINAL DOCUMENT: REVISION DATE: Authority Having Jurisdiction: APPROVAL DATE: Authority Having Jurisdiction SIGNATURE: Authority Having Jurisdiction: APPROVAL DATE: Authority Having Jurisdiction SIGNATURE: Authority Having Jurisdiction: APPROVAL DATE: Authority Having Jurisdiction SIGNATURE: Health Facilities Administration-Licensing 6/11/2015 Page 2 I.

c. Human resources 3. Attach the Continuity of Operations plan to Appendix H: Continuity of Operations. Continuity of Operations plan should include: a. Essential Functions b. Essential Records Management c. Orders of Succession d. Delegations of Authority e. Plans to continue to provide essential services during and after a disaster.

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