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Evaluation of Hospital Disaster Drills: A Module-Based Approach

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Decontamination Zone Module


This module was developed by the Johns Hopkins Evidence-based Practice Center under Contract No. 290-02-0018 from the Agency for Healthcare Research and Quality, Rockville, MD. The content of this module is intended to provide guidance for hospital disaster drill evaluation and should not be construed as representing standards of care or recommendations on how to respond to specific types of disasters. No statement in this module should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.


Note: Circle or check (_) as indicated. Y = Yes; N = No; U = Unclear; NA = Not applicable


Observer: __________________________________________________________             Date: ____/____/____

Observer title: _______________________________________________________

Hospital: ___________________________________________________________

Period of time of evaluation: _____________ AM / PM (Circle one) to _____________ AM / PM (Circle one)

Time Points

Event Time
C1. Time the drill began: (Circle one) _____________ AM / PM / U
C2. Time the hospital disaster plan was initiated in this zone: (Circle one) _____________ AM / PM / U / Not initiated
C3. Time this zone was ready to accept victims: (Circle one) _____________ AM / PM / U
C4. Time when this zone was notified that incident command was operational: (Circle one) _____________ AM / PM / U / Not initiated
C5. Time the drill ended in this zone: (Circle one) _____________ AM / PM / U
DE1. Time the first victim arrived in the decontamination zone: (Circle one) _____________ AM / PM / U

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Zone Description:

C6. Draw a picture of the zone setup.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Question Response

C7. Where was this zone located? (Check all that apply)

a. [  ] Ambulance ramp
b. [  ] Inside the hospital
c. [  ] Parking lot
d. [  ] Street/road
e. [  ] Other (specify):
________________________________

C8. Was the boundary for this zone defined?

Y / N / U
C9. If this zone had a defined boundary, how was it defined? (Check all that apply) a. [  ] Barricade(s)
b. [  ] Security personnel
c. [  ] Sign(s)
d. [  ] Tape
e. [  ] Vehicle(s)
f.  [  ] Wall(s), permanent
g. [  ] Wall(s), temporary
h. [  ] No boundary
i. [  ] Other (specify):
________________________________

C10. Were providers able to move easily through this zone?

Y / N / U

DE2. What type of area was used for decontamination? (Check all that apply) a. [  ] Covered designated outdoor decontamination area
b. [  ] Open outdoor decontamination area
c. [  ] Designated indoor decontamination room(s) (specify number of rooms): ________________________________
d. [  ] Other (specify):
________________________________

DE3. How close was the Emergency Medical System (EMS) offload to the decontamination area? (Enter approximate distance in feet)


________________________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Personnel

Question Response

C11. Did someone take charge of this zone?

Y / N / U
C12. If someone took charge of this zone, how many minutes after the drill activities in this zone began did this person take charge? (Check one) O < 10 min
O 10-29 min
O 30-59 min
O 1-2 hrs
O > 2 hrs
O NA

C13. If someone took charge of this zone, was it the officially designated person?

Y / N / U / NA

C14. How was the person in charge of the zone identified? (Check all that apply)

a. [  ] Arm band
b. [  ] Hat
c. [  ] Name tag
d. [  ] Verbal statement
e. [  ] Vest
f.  [  ] Not identified
g. [  ] Other physical identification (specify): __________________________________

C15. Were the following drill participants identifiable?

a. Drill evaluators Y / N / U / NA
b. Drill organizers Y / N / U / NA
c. Media Y / N / U / NA
d. Medical personnel Y / N / U / NA
e. Mock victims Y / N / U / NA
f. Observers Y / N / U / NA
g. Security Y / N / U / NA

C16-18. How many hospital drill participants were initially assigned to this zone? (Give approximate numbers)

C16. Physicians: __________________
C17. Nurses: __________________
C18. Ancillary personnel (registrars, security, cleaning staff, etc.):
__________________
C19. Were additional drill participants added during the drill?

Y / N / U

C20-22. If additional zone staff were added during the drill, what were their approximate numbers? (Leave blank if not applicable)

C20. Physicians: __________________
C21. Nurses: __________________
C22. Ancillary personnel (registrars, security, cleaning staff, etc.):
__________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Zone Operations

Question Response

C23. When was the location of this zone determined? (Check one)

O Determined before the drill
O Determined during the drill

C24. Was the hospital disaster plan available?

Y / N / U

C25. If the hospital disaster plan was available, what was its format? (Check all that apply)

a. [  ] Complete manual
b. [  ] Flow diagram
c. [  ] Job action sheets
d. [  ] No disaster plan
e. [  ] Other (specify):
________________________________

C26. If the hospital disaster plan was available, how was it accessed? (Check all that apply)

a. [  ] Computer/Internet
b. [  ] Paper
c. [  ] Personal data assistant (PDA)
d. [  ] Not accessed
e. [  ] Other (specify):
________________________________

C27. Was there a biological incident component to the hospital disaster plan?

Y / N / U

C28. Was there a radiation incident component to the hospital disaster plan? Y / N / U

C29. Was the space allocated for the zone adequate?

Y / N / U

C30. If not enough space for the zone, where did zone activities overflow to? (Check all that apply)

a. [  ] Adequate space allotted
b. [  ] Conference room
c. [  ] Hallways
d. [  ] Outside hospital
e. [  ] Treatment/victim care areas
f.  [  ] Waiting rooms
g. [  ] No overflow
h. [  ] NA
i.  [  ] Other (specify):
________________________________

C31. Was this zone used for the same functions during non-drill operations?

Y / N / U

C32. If this zone was not used for the same functions in non-drill operations, what was it usually used for? (Check all that apply)

a. [  ] Ambulance ramp
b. [  ] Conference room
c. [  ] Hallway
d. [  ] Lobby
e. [  ] Treatment, emergency
f.  [  ] Treatment, non-emergency
g. [  ] Triage
h. [  ] Unused
i.  [  ] Waiting room
j.  [  ] Other (specify):
________________________________

C33. Did clinical staff interact directly with families of victims?

Y / N / U / NA

C34. Were families of victims referred to specially designated staff? Y / N / U / NA

C35. How was victims' privacy ensured?  (Check all that apply)

a. [  ] Curtains
b. [  ] Individual areas
c. [  ] Privacy screens
d. [  ] Not ensured
e. [  ] Other (specify):
________________________________

Question Response

DE4. Was the decontamination zone set up prior to arrival of first victim?

Y / N / U

DE5. Were all victims sent immediately through decontamination on arrival in this zone?

(If not sent immediately to decontamination, explain in the comments box at the end of the section.)

Y / N / U

DE6-7. How many victims were able to undergo decontamination simultaneously?
(Give approximate numbers)

DE6. Ambulatory: __________________
DE7. Non-ambulatory: __________________

DE8. How were non-ambulatory victims decontaminated? (Check all that apply)

a. [  ] Victims and means of transport were put through decontamination
b. [  ] Victims were transferred to another means of transport and then put through decontamination
c. [  ] No non-ambulatory victims
d. [  ] Other (specify):
_________________________________

DE9. Were non-ambulatory victims repositioned to ensure decontamination of all surfaces?

Y / N / U / NA

DE10. Were separate provisions made for male and female victims? Y / N / U / NA

DE11. Were victims’ clothing and personal belongings removed during decontamination?

Y / N / U

DE12. If yes, what was done with their clothing and personal belongings? (Check all that apply)

Clothing

a. [  ] Chain of custody initiateda
b. [  ] Contained
c. [  ] Discarded
d. [  ] Held for later retrieval
e. [  ] Identified
f.  [  ] Marked as hazardous materials
g. [  ] Returned after decontamination
h. [  ] Secured in storage
i.  [  ] Unclear
j.  [  ] NA
k. [  ] Other (specify):
_________________________________

Personal Belongings

l.   [  ] Chain of custody initiateda
m. [  ] Contained
n.  [  ] Discarded
o.  [  ] Held for later retrieval
p.  [  ] Identified
q.  [  ] Marked as hazardous materials
r.  [  ] Returned after decontamination
s.  [  ] Secured in storage
t.   [  ] Unclear
u.  [  ] NA
v.  [  ] Other (specify):
_________________________________

DE13. If victims’ items were contained, what materials were used for containing clothing and personal items? (Check all that apply)

a. [  ] Aluminum foil wrapping
b. [  ] Cotton hampers
c. [  ] Paper bags
d. [  ] Plastic bags
e. [  ] NA
f.  [  ] Other (specify):
_________________________________

DE14. Were any measures taken to improve victims' comfort? (Check all that apply)

a. [  ] Heaters
b. [  ] Partitions
c. [  ] Shelters
d. [  ] Towels
e. [  ] None
f.  [  ] NA
g. [  ] Other (specify):
_________________________________

DE15. Were any additional steps taken when handling materials or equipment that came into contact with potentially contaminated victims?

(If additional steps were taken, explain in comments box at the end of this section.)

Y / N / U / NA

DE16. Was covering provided to victims after decontamination?

Y / N / U / NA

DE17. Were there any barriers between this zone and the next? (Check all that apply)

a. [  ] Doors
b. [  ] Elevators
c. [  ] No barriers
d. [  ] Stairs
e. [  ] Other (specify):
________________________________

DE18. Did the Emergency Medical Service (EMS) provide any of the following resources to assist in decontamination? (Check all that apply)

a. [  ] Decontamination tents
b. [  ] Fire trucks with hoses
c. [  ] Personal protective equipment
d. [  ] Personnel
e. [  ] Water containment systems
f.  [  ] No services provided
g. [  ] Other (specify):
________________________________

DE19. Mechanism of decontamination? (Check all that apply and estimate the number)

a. [  ] EMS or fire department vehicles with hoses: ________________________________
b. [  ] Permanent overhead showers/sprinklers: ________________________________
c. [  ] Temporary decontamination tent(s): ________________________________
d. [  ] Other (specify):
________________________________

DE20. Was contaminated water run-off contained? (Check one)

O Yes, and adequate collection capacity
O Yes, but inadequate collection capacity
O No, but runoff directed into drainage system
O No runoff control
O Unclear

DE21. Did the decontamination zone affect the normal flow of EMS traffic?

Y / N / U / NA

DE22. Was an established plan in place for re-routing the EMS traffic? Y / N / U / NA

DE23. Was the EMS notified of the change in traffic flow?

Y / N / U / NA

DE24. If yes, how? (specify): ________________________________

a Chain of custody is defined as securing items continuously and marking evidence gathered by date, time, location, and when, how, and by whom acquired. It includes signatures of all persons successively responsible for custody. It must be conducted so the validity of the chain of custody will hold up in court.

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Communications

If device not present, circle "N" in column "a" and go to the next line.

Communication Device(s) a. Was device present? b. If present, # available c. If present, was it used in drill? d. Comments (note problems)
Phone
C36. 2-way radio/phone(s) Y / N / U   Y / N / U  
C37. Direct line(s) Y / N / U   Y / N / U  
C38. Landline phone(s) Y / N / U   Y / N / U  
C39. Wireless/cell phone(s) Y / N / U   Y / N / U  
Radio and Television
C40. AM/FM radio(s) Y / N / U   Y / N / U  
C41. Television(s) Y / N / U   Y / N / U  
Pager
C42. Numeric paging Y / N / U   Y / N / U  
C43. Overhead paging Y / N / U   Y / N / U  
C44. Text paging Y / N / U   Y / N / U  
Other Electronic Device
C45. E-mail & Internet access Y / N / U   Y / N / U  
C46. FAX machine(s) Y / N / U   Y / N / U  
Voice or Physical Communication Device
C47. Intercom Y / N / U   Y / N / U  
C48. Megaphone(s) Y / N / U   Y / N / U  
C49. Runner(s) Y / N / U   Y / N / U  
Other (Specify)
C50. ______________________ Y / N / U   Y / N / U  
C51. ______________________ Y / N / U   Y / N / U  
C52. ______________________ Y / N / U   Y / N / U  

Question Response
C53. How was incoming information to the zone recorded? (Check all that apply) a. [  ] Computer (other electronic device)
b. [  ] Notepaper
c. [  ] Posted paper
d. [  ] White board/chalk board
e. [  ] Not recorded
f.  [  ] Other (specify):
________________________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Information Flow

Question Response

C54. How was this zone notified of the event? (Check all that apply)

a. [  ] FAX
b. [  ] Runner
c. [  ] Telephone
d. [  ] Not notified
e. [  ] Other (specify):
________________________________

C55. Who notified this zone of the event? (Check all that apply)

a. [  ] Drill organizer
b. [  ] Incident command center
c. [  ] Media
d. [  ] Other hospital staff
e. [  ] Outside source
f.  [  ] Victims arriving
g. [  ] Not notified
h. [  ] Other (specify):
________________________________

C56. Did your zone receive updates regarding the situation outside the hospital
(e.g., status of disaster events, number of victims arriving, acuity of victims)?

Y / N / U

C57. If your zone received regular updates, who sent them? (Check all that apply)

a. [  ] City/State health department
b. [  ] Emergency Medical System
c. [  ] Incident command center
d. [  ] Media
e. [  ] State disaster agency
f.  [  ] Did not receive
g. [  ] Other (specify):
________________________________

C58. How was this zone kept aware of the ongoing general situation within the hospital? (Check all that apply)

a. [  ] Call(s) from incident command
b. [  ] FAX from incident command
c. [  ] Other contact from incident command
d. [  ] Runner(s) from incident command
e. [  ] Contact from other internal sources (specify): ________________________________

C59. Were problems created by delays in receiving information?

(If problems were created by delays in information, specify in comment box at end of this section.)

Y / N / U

DE25. When was your zone made aware of the actual chemical or radiation agent? (Check one)

O Before the first victim arrived
O After first victim arrived
O All victims completed decontamination
O Never made aware
O Unsure

DE26. What was this zone's understanding of the causative agent? (Check all that apply)

a. [  ] Chemical
b. [  ] Radiation
c. [  ] Unclear
d. [  ] No understanding
e. [  ] Other (specify):
________________________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

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Security

Question Response

C60. Were security personnel present in this zone?

Y / N / U

C61. If security were needed but not present, how were they contacted? (Check all that apply) a. [  ] 2-way radio/phone
b. [  ] Overhead pager
c. [  ] No security present
d. [  ] Other (specify):
________________________________

C62. If security personnel were present, what type of security? (Check all that apply and provide approximate numbers)

a. [  ] FBI: ________________
b. [  ] Hospital security: ___________
c. [  ] Local police: __________
d. [  ] State police: _______________
e. [  ] NA
f.  [  ] Other (specify):
________________________________

C63. Did all security staff present have a portable means of communication?

Y / N / U / NA

C64. Were entrances and exits strictly controlled in this area? Y / N / U / NA

Did any of the following security issues arise in this zone?

If the security issue did not arise, circle "N" in column "a" and go to the next row.

Security Issue a. Arose? b. If yes, did security respond? c. If yes, was order maintained? d. Description of issue and measures taken
C65. Access in and out Y / N / U Y / N / U Y / N / U  
C66. Assistance for family members Y / N / U Y / N / U Y / N / U  
C67. Assistance lifting supplies or victims Y / N / U Y / N / U Y / N / U  
C68. Crowd control Y / N / U Y / N / U Y / N / U  
C69. Media control Y / N / U Y / N / U Y / N / U  
C70. Transportation/ traffic control Y / N / U Y / N / U Y / N / U  
C71. Unruly victims Y / N / U Y / N / U Y / N / U  
C72. Other (specify):
________________________________
Y / N / U Y / N / U Y / N / U  
C73. Other (specify):
________________________________
Y / N / U Y / N / U Y / N / U  

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Victim Documentation and Tracking

Question Response

C74. Were all incoming victims registered and given a unique identification or medical record number? (Check one)

O Yes, before entering this zone
O Yes, on entering this zone
O No, not while in this zone
O Unclear

C75. What was the method of documenting the victim record in this zone? (Check all that apply)

a. [  ] Computer entry
b. [  ] Data card(s) attached to victims
c. [  ] Dictation system
d. [  ] Personal data assistant (PDA)
e. [  ] Scanner
f.  [  ] Separate victim paper chart
g. [  ] No documentation
h. [  ] Other (specify):
________________________________

C76. Was a central list of victims generated for this zone?

Y / N / U

C77. Were the triage markers on the victims clearly visible? Y / N / U

C78. Did the triage markers stay affixed to the victims while in this zone?

Y / N / U / NA

C79. Was clinical information about victims accessible to caregivers? Y / N / U / NA

C80. What proportion of victims arriving in this zone were labeled with a triage level? (Check one)

O None
O Less than half
O At least half (but not all)
O All
O NA

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Victim Flow

Question Response

C81. Did a bottleneck develop in this zone?

(If a bottleneck did develop, describe in the comment box at the end of this section.)

Y / N / U

C82. What was the maximum number of victims observed waiting at the bottleneck at any time? (Check one)

O 0
O 1-10
O 11-25
O 26-50
O 51-100
O > 100
O Unclear

C83. Was the bottleneck resolved?

(If the bottleneck was resolved, describe in the comment box at the end of this section.)

Y / N / U / NA

C84. Were the paths leading to the next zone marked?

Y / N / U

C85. If the paths were not marked, were verbal directions given by zone staff? Y / N / U / NA

C86. Were the lowest acuity victims directed by staff to an area separate from higher acuity victims?

Y / N / U

C87. What proportion of victims had treatment delayed because of zone staffing shortage? (Check one)

O None
O Less than half
O At least half (but not all)
O All
O NA

C88. Were expiring victims placed in a quiet and separate place?

Y / N / U / NA

C89. Were deceased victims rapidly removed from this zone? Y / N / U / NA

C90. How many victims passed through this zone? (Check one)

O 0
O 1-10
O 11-25
O 26-50
O 51-100
O > 100
O Unclear

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Personal Protective Equipment (PPE) and Safety

If needed, were these items for standard precautions available for the health care workers?

If safety materials were not available, circle "N" in column "a" and go to the next row.

Safety Materials a. Available? b. Used by staff? c. Adequate Supply?
C91. Eye protection Y / N / U Y / N / U Y / N / U
C92. Waterproof gowns Y / N / U Y / N / U Y / N / U
C93. Isolation gowns Y / N / U Y / N / U Y / N / U
C94. Gloves Y / N / U Y / N / U Y / N / U
C95. Other (specify): _______________ Y / N / U Y / N / U Y / N / U
C96. Other (specify): _______________ Y / N / U Y / N / U Y / N / U
C97. Other (specify): _______________ Y / N / U Y / N / U Y / N / U

Question Response

DE27. Were staff dressed in PPE prior to the arrival of the first victim?

Y / N / U / NA

DE28. Did the first arriving victims have to wait for staff to don PPE? Y / N / U

DE29. Was decontamination equipment fully assembled on arrival of the first victim?

Y / N / U

DE30. Did uncontaminated staff or victims mix with contaminated staff or victims? Y / N / U

DE31. Were there any problems with the PPE? (Check all that apply)

a. [  ] Broken seals
b. [  ] Communication
c. [  ] Delay in donning PPE
d. [  ] Improper fit
e. [  ] Over-heating of staff
f.  [  ] Staff unable to dress in PPE
g. [  ] Unclear
h. [  ] No problems observed
i.  [  ] Other (specify):
_________________________________

DE32. How did staff dressed in PPE communicate with victims? (Check all that apply)

a. [  ] Hand signal(s)
b. [  ] Pre-printed sign(s)/card(s)
c. [  ] Removed or adjusted PPE to talk
d. [  ] No communication observed
e. [  ] NA
f.  [  ] Other (specify):
___________________________________

DE33. Were staff relieved at regular intervals to prevent fatigue and overheating?

Y / N / U

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

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Equipment and Supplies

There are no items for this section in the decontamination zone module.

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Rotation of Staff

Question Response

C98. Was there a staff rotation/shift change?

Y / N / U

C99. If there was a staff rotation, did the officially designated person in charge of the zone change? Y / N / U / NA

C100. If there was a staff rotation, did problems arise?

(If problems arose, explain in comments box at the end of this section.)

Y / N / U / NA

C101. What method of shift changing was used? (Check one)

O Group shift change
O Staggered shift change
O NA
O Other (specify):
________________________________

C102. How were incoming staff updated? (Check all that apply)

a. [  ] Group briefing
b. [  ] Individual briefing
c. [  ] Written notes
d. [  ] Not updated
e. [  ] NA
f.  [  ] Other (specify):
________________________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Zone Disruption

Question Response

C103. Was there a plan in place to relocate this zone if necessary?

Y / N / U

C104. Did this zone close at any time during the drill?

If no, disregard the remainder of this section. STOP. This zone module is complete.

Y / N / U

C105. If the zone closed during the drill, what was the reason for closing? (Check all that apply)

a. [  ] Contamination
b. [  ] Other safety concerns
c. [  ] Space
d. [  ] Other (specify):
________________________________

C106. If the zone closed during the drill, was the incident command center notified?

Y / N / U

C107. If the zone closed during the drill, were other zones notified? Y / N / U

C108. If the zone closed during the drill, did it reopen in the same location?

Y / N / U

If the zone did reopen in the same location:

   C109. Were operations interrupted until this zone reopened?

Y / N / U / NA

   C110. Was the incident command center notified when this zone reopened? Y / N / U / NA

   C111. Were other zones notified when this zone reopened?

Y / N / U / NA

   C112. Were any critical issues observed with reopening this zone?

   (If critical issues were observed, explain in the comments box at the end of this section.)

Y / N / U / NA
C113. If the zone did NOT reopen in the same location, was an alternate site opened? Y / N / U / NA

If the zone reopened in an alternate site:

   C114. Where did the zone reopen? (specify): ____________________________________________________________
   C115. Did the initial zone close before the new zone opened?

Y / N / U / NA

   C116. Were operations interrupted until this zone reopened? Y / N / U / NA
   C117. Was the incident command center notified of this zone's relocation?

Y / N / U / NA

   C118. Were other zones notified of this zone's relocation? Y / N / U / NA
   C119. Were portable means of communication used while relocating this zone?

Y / N / U / NA

   C120. Were any critical issues observed with this relocation?

   (If critical issues were observed, explain in the comments box at the end of this section.)

Y / N / U / NA

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

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