NYC-WTC_000233682

NYC 9/11 Public Portal Document

response guidelines

5.4 Public Health Response Action Worksheet

INSTRUCTIONS The purpose of this form is to heip organize information to aid in the evaiuation of containment options and pubiic notification options. The objectives of public health response actions (operational and public notification) are to prevent or limit public exposure to potentially contaminated water by either restricting further propagation of the contaminant through the distribution system or restricting use of the water through public notification. This worksheet assumes that the “Contaminant Characterization and Transport Worksheet” in Section 5.3 has been completed to the extent possible.

ASSESSMENT OF PUBLIC HEALTH IMPACT

Identity of the contaminant □ Suspected □ Known □ Unknown Describe

Contaminant properties (if known): Toxic or infectious dose (LD50/ID50): Route of exposure: □ Ingestion □ Inhalation □ Dermal Contact □ Other Symptoms of exposure to high dose: Symptoms of exposure to low dose: Other:

EVALUATION OF CONTAINMENT OPTIONS

Describe the location and extent of the contaminated area.

Containment options □ Valve closures □ Reverse flow conditions □ By-pass □ Isolate zone(s) □ Other

Critical equipment within contaminated area □ System equipment □ Zones □ Pumpstations □ Hydrants □ Other

Customers with special needs within contaminated area □ Critical Care Facilities □ Hospitals □ Clinics □ Nursing Homes □ Dialysis Centers □ Other □ Schools □ Businesses □ Food and Beverage Manufacturers □ Commercial Ice Manufacturers □ Restaurants □ Agricultural Operations □ Power Generation Facilities □ Other

61 Interim Final - August 2004

CITY_21MC100_0 04992400

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