[Protective Marking]

Homeland Security Exercise and Evaluation Program (HSEEP)[Full Exercise Name]

Actor Information Sheet [Exercise Name Continued]

ACTOR INFORMATION SHEET

The Actor Information Sheet should be distributed to actors before the exercise and should accompany the Actor Waiver Form. This information sheet is provided as an example only and should be modified to suit the jurisdiction’s needs as well as the exercise scope, type, and scenario. For example, if decontamination will not be part of the exercise, actors do not need to be instructed to wear bathing suits.

Please read and understand the following points; they will ensure that your participation in this exercise will be safe and enjoyable. If you have any questions, please contact [Actor POC].

1. The day will be long and tiring.

You need to be at the site by [time], and you will probably not finish until after [time]. If you have any health concerns or medical conditions, please tell [Actor POC] before the start of the exercise. Health or medical concerns will not necessarily disqualify you from participating.

2. You must be at least 18 years old and sign a waiver to participate.

If you are not 18 and are not in the military, parental permission is required to participate. The waiver form (included) must be turned in before the exercise to [Actor POC].

3. Eat a good breakfast before arrival.

It is your responsibility to eat a well-balanced meal before arriving at the exercise, [just in case you miss some of the food provided.]

[Exercise officials are planning a snack and limited beverages before the exercise. Volunteers transported to hospitals will be given a snack before being returned to the exercise site. Volunteers who do not leave the exercise site will be released before lunch.]

4. Transport yourself to and from the exercise site.

You are responsible to transport yourself to [exercise location]. A map is attached for your convenience. If you carpool with another volunteer, there is no guarantee that you will be returned to the exercise site at the same time.

5. Be on time!

Please do not arrive late. It is difficult to begin the exercise if actors are not in place.

You will most likely be released by [time]. However, you may finish earlier or later. Volunteers transported to hospitals will be returned to the exercise site.

6. Wear layers of old clothes and a bathing suit.

Wear clothes that can be removed and a bathing suit underneath. Wear clothes that you do not mind getting wet, dirty, stained, or torn. You will get wet.

[Section Title] 1 [Jurisdiction][PROTECTIVE MARKING]

[Protective Marking]

Homeland Security Exercise and Evaluation Program (HSEEP)[Full Exercise Name]

Actor Information Sheet [Exercise Name Continued]

ACTOR WAIVER FORM

On behalf of [Jurisdiction], we thank you for volunteering to be a simulated casualty for our preparedness exercise. The event is scheduled for [date]. Actors should report to [location] at [time].

Exercise Overview

You will be participating as a mock victim of a [scenario]. You will be triaged and either directed or taken to an area where appropriate decontamination will occur, potentially including cutting of your clothing. You will be washed and reclothed. Alternative garments will be provided. Please wear a bathing suit, shorts, and T-shirt, and bring a change of clothes and towel. We would appreciate your wearing loose-fitting and easily removable shoes. It is recommended that you do not wear jewelry. Jewelry and personal items will be removed during the decontamination process, bagged, and given to you to carry as you go through the decontamination line.

Before the event, you will be given a complete orientation to the incident site, the type of injury or symptoms you should simulate, and what actions are expected of you.

Please eat a meal and drink plenty of liquids before you come. After the event, food and refreshments will be available for you. Restrooms also will be available for your convenience.

Please Print Name, Sign, and Date

I, _______________________________________, agree to participate in the [sponsor name]-sponsored exercise on [conduct date]. I agree to go through the decontamination process. I will hold harmless [Jurisdiction] and any other agency or its members participating in this exercise. I understand that all reasonable and customary safety measures will be performed to try to prevent injury or harm to me.

Signature: Date:

Signature of parent or guardian (if under 18): Date:

[Section Title] 2 [Jurisdiction][PROTECTIVE MARKING]

[Protective Marking]

Homeland Security Exercise and Evaluation Program (HSEEP)[Full Exercise Name]

Actor Information Sheet [Exercise Name Continued]

AREA MAPS

Figure 1. [Map Title]

[Insert map]

Figure 2. [Map Title]

[Insert map]

[Section Title] 3 [Jurisdiction][PROTECTIVE MARKING]