Form 1 Rev.

4/7/2007
Republic of the Philippines
Department of Health
HEALTH EMERGENCY MANAGEMENT STAFF
2nd Flr. ER Trauma Ext. Bldg., East Avenue Medical Center, Quezon City
Telefax: (63-2)929-6853 / 929-6919 / 929-6827 Tel: (63-2)929-6887 / 929-6923
Email: doh_hems@yahoo.com

HEARS FIELD REPORT

(Upon learning about the occurrence of an event, the HEMS Coordinator shall immediately inform the DOH-HEMS Operation Center
through the fastest communication means available. Then this Form 1 shall be filled-out and sent ASAP or within 24 hours upon
occurrence of the event.)

A. Event Information
Type of Event: GEOLOGIC WEATHER BIOLOGIC MAN-MADE
Volcanic Eruption Typhoon Red Tide Epidemic Poisoning, specify ______________
Earthquake Storm Surge Fish Kills Fire Mass Action, specify____________
Tsunami Drought Locust Explosion Accident, specify :Vehicular
Landslide Cold Spell Infestation Armed Conflict Other, specify_
Lahar Flashflood Terrorism
Date of Ocurrence: Time of AM Exact Location: district 3,purok 2,3 san juan accfa Cabanatuan city
JULY 28,2017 Occurrence:7:30 PM Region:3 Province:Nueva Ecija Municipality/City:Cabanatuan city
Brief Description (How the event happened):
On july 28,2017 at about 7:30 PM, Monsoon rains caused by typhoon Gorio flooded several parts of district 3
particularly purok 3 and the entire purok 2 of Brgy San Juan Accfa, Cabanatuan City, NE. The said flood reached
above knee level and affected more or less than 215 families but none of them leave their residences or went to
designated evacuation areas.

B. Consequences (Supply as much data as possible within 24 hours)

HEALTH IMPACT POPULATION DISPLACEMENT HEALTH FACILITIES / SERVICES
No. of Deaths: Population displaced? Yes No Number Number
No. of Admitted Patients: No. of Displ. Families: Estimated Available Functional
No. of Outpatients: Actual Public
No. Missing: No. of Disp. Individuals: Actual Hospitals:
Estimated RHUs:

C. Actions Taken (Include information on number and types of services, manpower and supplies provided in the field)
1. CLOSED MONITORING OF AREA
2.
3.

D. Assistance Needed (Include information on number and types of services, manpower and supplies needed in the field)
1.

2.

3.

Prepared and Submitted by:

Date Prepared: JULY 28,2017 Mobile No.:
Signature: Landline:
Printed Name: MERCY G. WENCESLAO Fax No.:
Designation/Office: NDP-CHC 4 MABINI HOMESITE Email:
CABANATUAN CITY, N.E.