LARA - Fire Watch and Emergent Event Reporting System

Fire Watch and Emergent Event Reporting System

Natural disasters lasting more than 6 hours that may require evacuation of residents such as loss of heat, power, water, or food service
Outside/external threats to resident/patient well-being such as bomb threats, active shooter in facility, suspicious mail/written verbal threats
Critical lack of staff due to severe weather, labor disputes, or widespread illness that has critical impact on resident/patient care

Facility Name:		Facility Type:
Facility ID:	CCN Number:
Address:	City:	County:
Brief Description of Event: Number of Beds Affected (approx.):	Start Date: Start Time:	Type of Event: *Other:
	End Date: End Time:
Contact Person:	Primary Phone:	Secondary Phone:
Title:	Email:
* Spam Block: (What's this?) Add "nine" plus "four" and type the numeric (integer) answer here: