Pandemic influenza

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Exercise Cruickshank forms and templates

Evaluation templates

Formal exercise communication template

Information report form

Intelligence summary form

Inject template

Inject response tracking sheet

Master issues log

Phone/email issues log

Response receipt cover sheet

Request for assistance form

Request for information form

Situation report forms

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Evaluation templates

All evaluators

• Assessment report (Word, 27 KB)
• EXCON evaluation (Word, 33 KB)

Border management site evaluator

• Border management site evaluator - Day one (Word, 90 KB)

District Health Board evaluators

• District Health Board EOC evaluator (CBAC Operations only) (Word, 68 KB)
• District Health Board/Public Health Unit EOC evaluator - Day one (Word, 86 KB)
• District Health Board/Public Health Unit EOC evaluator - Day two (Word, 163 KB)
• District Health Board/Public Health Unit EOC evaluator - Day three (Word, 99 KB)

Environmental Science and Research (ESR) evaluator

• Environmental Science & Research evaluator - Day one (Word, 53 KB)
• Environmental Science & Research evaluator - Day two (Word, 46 KB)

Exercise players

• Evaluation form for exercise players (Word, 70 KB)

Ministry of Education evaluator

• Ministry of Education evaluator - Day two (Word, 46 KB)

National Health Coordination Centre (NHCC) evaluator

• National Health Coordination Centre evaluator - Day one (Word, 102 KB)
• National Health Coordination Centre evaluator - Day two (Word, 106 KB)
• National Health Coordination Centre evaluator - Day three (Word, 92 KB)

National intersectoral evaluator

• National Intersectoral evaluator - Day one (Word, 99 KB)
• National Intersectoral evaluator - Day two (Word, 94 KB)
• National Intersectoral evaluator - Day three (Word, 113 KB)

Other national agency evaluator

• Other national agency evaluator - Day one (Word, 60 KB)
• Other national agency evaluator - Day two (Word, 60 KB)
• Other national agency evaluator - Day three (Word, 72 KB)

Formal exercise communication template

• Exercise exercise communication template (Word, 20 KB)

Information report form

• Information report form (Word, 42 KB)

Intelligence summary form

• Intelligence summary form (Word, 51 KB)

Inject template

• Inject template (Word, 91 KB)

Inject response tracking sheet

• Inject response tracking sheet (Word, 25 KB)

Master issues log

• Master issues log (Excel, 21 KB)

Phone/email issues log

• Phone/email issues log (Word, 27 KB)

Response receipt cover sheet

• Response receipt cover sheet (Word, 20 KB)

Request for assistance form

• Request for assistance form (Word, 30 KB)

Request for information form

• Request for information form (Word, 41 KB)

Situation report forms

• NHCC situation report form (Word, 61 KB)
• DHB situation report form (Word, 95 KB)

Page last reviewed: October 2007