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PRINTED: 08/01/2024
FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
IDENTIFICATION
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Read the survey instructions carefully before beginning.
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What is preparedness survey conducted on?
The preparedness survey is conducted on assessing the readiness and capability of organizations or individuals to respond to emergencies and disasters.
Who is required to file preparedness survey conducted on?
Organizations, institutions, or entities that are involved in emergency management or risk assessment activities are typically required to file the preparedness survey.
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To fill out the preparedness survey, complete the provided form with accurate information about emergency plans, resources, training, and capabilities, ensuring all sections are addressed.
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The purpose of the preparedness survey is to evaluate readiness, identify gaps in emergency planning, and improve response strategies for potential disasters.
What information must be reported on preparedness survey conducted on?
The survey must report information on emergency response plans, training programs, available resources, communication strategies, and recent drills or exercises conducted.
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