HICS Staff Redeployment Survey

Please complete the following survey so that we can determine your availibility in the case of an actual HICS event.

First Name

Last Name

Department

Immediate Supervisor

Please provide us with the best number to reach you.

Work Telephone

Home Phone

Cell Phone

Memorial Sloan Kettering Email Address

Confirm email

Wednesday Availability

Not Available

11 PM to 7 AM

Please provide detailed answers when appropriate.

If you have worked during an emergency previously, what did you do?

What medical, nursing, or allied health training or experience do you have?

Leave this field blank

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