HDRA form
Variable Name Field Label Identifier?
record_id
Record ID
id
Study Number
healthcare_fac_name
Name of Healthcare Facility
fac_address
Address of Facility
fac_head
Head of Institution Name & Designation
consent_date
Consent Statement
1. I confirm that I have read and understood the information sheet dated _________________ for the above study and have had the opportunity to ask questions.
2. I understand that my participation in this study is voluntary and that I am free to withdraw at any time, without giving any reason and without affecting my facility's relationships with any public or private organizations.
3. I understand that the Ethics Committee and regulatory authorities may review facility records relating to this study and any future research without requiring my permission, although my facility's identity will not be revealed in any published information.
4. I agree not to restrict the use of any data or results arising from this study, provided such use is only for scientific purposes and does not compromise facility confidentiality.
5. I agree to participate in this combined assessment tool (questionnaire and scoring) and provide voluntary consent for my facility's participation.
sign_date
Date
reprsentative_name
Name and Designation
investigator_sign
PI/Investigator Signature
date
Date
investigator_name
Investigator Name
witness_date
Date
witness_name
Witness Name
fac_name
Facility name
fac_add
Address (Full)
fac_location
City/District/State
date_assessment
Date
fac_contact_detail
Email and Website
fac_accreditation
NABH/NRHM/Other Accreditation
fac_occupancy
Hospital Occupancy Rate
fac_services
Departments/Services operational
key_person
Key Personals Present (Name & Designation)
decriptive
Assessment Instructions
Rate the facility's exposure to and experience with each hazard using the scale: 1 = Very High/Severe, 2 = High, 3 = Moderate, 4 = Low, 5 = Not Severe/Not Frequent
Refer to hazard maps (available from district authorities), past event records, and facility disaster history when scoring. Document observations (e.g., "2019 earthquake 5.2M caused minor crack in east wall").
landslides
Land Slides
landslide
Land Slides
land_slide_observation
Land Slide
flood
Last Flood
epidemeological_risk
Epidemic/Pandemic Risk
animal_incident
Snake/Animal Bite Incidents
vector_name
Endemic Species
industrial_hazard
Industrial Accidents/Spills
village_distance
Village/Settlement (in KM)
village_density
Population density
shelter_capacity
Capacity
village
Village/ settlement
maintenance_structure
Last Maintenance
damage_type
Type of Damage
age
Age of Building
past_damage
Past Damage from Disasters
signage
Exit Signage & Lighting
triage
Triage/Decontamination Areas
indicators
Indicator
1=Absent; 2=Not marked; 3=Incorrectly marked; 4=Partially marked; 5=Clearly demarcated
1=None; 2=Identified; 3=Partially marked; 4=Marked; 5=Marked & sheltered
1=None; 2=Poor; 3=Moderate; 4=Good; 5=Comprehensive
1=Not designated; 2=Inadequate; 3=Adequate; 4=Well-designed; 5=Multi-purpose & functional
assembly_capacity
Capacity (in Numbers)
location_triage
Location
hospital_capacity
D.3 Hospital Capacity & Surge Capacity
gen_expansion
Expansion Capacity (beds/areas)
surg_expansion
Expansion Capacity (beds/areas)
pedia_expansion
Expansion Capacity (beds/areas)
icu_expansion
Expansion Capacity (beds/areas)
emergency_expansion
Expansion Capacity (beds/areas)
ot_expansion
Expansion Capacity (beds/areas
isolation_expansion
Expansion Capacity (beds/areas)
others_capacity
Other (specify)
other_expansion
Expansion Capacity (beds/areas)
surge_capacity
Hospital and surge capacity
emer_utilitity
Utilities (Water/Power/Phone)
ins_date
Last Inspection
ins_main
Maintence record
emer_elec
Electricity
emer_gas
Medical Gases (O2, Vaccum)
emer_equip
Medical Equipment
water_expire
Expiry management
fuel_expire
Expiry management
elec_gener
Generator Electric Building Capacity (kW)
gas_expire
Expiry Management
med_expire
Expiry Management
food_expire
Expiry Managemnet
safety_insp
Last Inspection
medical_waste
Medical Waste Management
water_cap
Toilet capacity
waste_manage
3-bucket system
hazard_handling
Chemical storage
food_pois
Food Safety
Food poisoning incidents
disaster_train_date
Last training date
disaster_drills_date
Last Drill Date
disaster_cpr_train
Last Training
disaster_firstaid
First Aid
disaster_first_train
Last Training
disaster_safety_train
Last Training
disaster_triage
Triage & Mass Casualty Management
disaster_triage_train
Last Training
disaster_triage_cert
Certification
disaster_triage_protocol
Protocol
disaster_haz_train
Last Training
disaster_swim_train
Last Training
disaster_staff_motivation_indicators
1=None; 2=< 10% salary; 3=10-20%; 4=21-40%; 5=>40% incentive
1=Rigid; 2=Limited; 3=Moderate; 4=Adequate; 5=Flexible & supportive
1=None; 2=Ad-hoc; 3=Some counseling; 4=Regular support; 5=Integrated program
disaster_govern_stake
Stakeholder Engagement
icc
G.2 Incident Command Centre (ICC)
telephone_direct
Telephone Directory
icc_telephone
Telephone lines
icc_telephone_radio
2-way Radios
disaster_management_plan
G.3 Disaster Management Plans & Standard Operating Procedures
triage_protocol
Triage Protocol
hdmp_indicators
SOPs & Protocols 1=None; 2=Basic; 3=Comprehensive; 4=Detailed & tested; 5=Dynamic & regularly updated
Disaster Codes (Color/Number System) 1=Not defined; 2=Defined only; 3=Defined & trained; 4=Displayed; 5=Operational with drills
Staff Action Cards 1=Absent; 2=Few; 3=Partial distribution; 4=All staff; 5=All staff + reviewed
Triage Protocol 1=Absent; 2=Basic; 3=Established; 4=Tested; 5=Functional & exercised
hdmp_status
Hospital Disaster Management Plan (HDMP)
hdmp_version
HDMP version date
idsdmp_status
Integration with District/State DM Plan
idsmp_alingmnet
Alingment
triage_code_category
Triage Categories
mock_drill_date
Last Mock Drill Date
variation_identified
Rate How many issues found during drills
postdrill_reprot_date
Date
mcmr
G.5 Mass Casualty Management Readiness
capacity_planing
Surge Capacity Planning
triage_areas
Triage Area Setup
casualty_flow
Casualty Management Flow
psycho_first_aids
Psychological First Aid for Victims
mass_indicators
Surge Capacity Planning 1=Not planned; 2=Basic; 3=Outlined; 4=Detailed; 5=Tested through drills
Triage Area Setup 1=Not designated; 2=Identified; 3=Partially prepared; 4=Well-designed; 5=Functional & stocked
Casualty Management Flow 1=Undefined; 2=Basic; 3=Documented; 4=Trained; 5=Practiced & monitored
Morgue/Mortuary Facilities 1=Inadequate; 2=Minimal; 3=Moderate; 4=Good; 5=Adequate with contingency
Psychological First Aid for Victims 1=Not available; 2=Ad-hoc; 3=Some provision; 4=Trained personnel; 5=Integrated support
Family Support/Information System 1=Not planned; 2=Basic; 3=Outlined; 4=Detailed; 5=Tested & functional
mass_surge_capacity_assum
Assumed Casualty Numbers
triage_area
Triage Area setup Area size (m²)
morgue_capacity
Morgue/Mortuary Facilities capacity
psych_first_aid
Personnel trained Psychological First Aid for Victims
budget_allocation_for_disaster_managemnet
H.1 Budget Allocation for Disaster Management
commu_engage_amount
Amount Allocated (₹)
comm_engage_amount_per
% of Total Budget
comm_engage_amount_status
Status
intern_agencies
International Agencies
resource_mobile_intern_agency_support
Funding/Technical support
comm_local_agency
Community/ local resources
engage_ngo
Engagement with NGOs/Red Cross
int_age_col_fre
Frequency (1=Not conducted, 5=Monthly)
engage_ngo_redcross
Engagement with NGOs/Red Cross
int_age_colab_quality
Quality (1=Poor, 5=Excellent)
last_test_date
Last test Date
k_1_key_strengths_list_3_5
K.1 Key Strengths
List 3-5 major strengths identified in the facility's disaster preparedness:
identify_priority_gaps_tha
Identify priority gaps that require immediate attention
name_designation
Name & Designation
assessment_date
Date
contact_phone
Contact Phone
contact_email
Contact email
name_and_designation
Name and Designation
auth_date
Date
witness_name_and_designation
Name And Designation
witness_dates
Witness Date
Information sheet
Variable Name Field Label Identifier?
information_sheet
Information Sheet for Healthcare Facility Participants
Who Am I?
My name is Nidhi Yadav, and I am a doctoral researcher at IIHMR University, Jaipur. I am conducting research to explore the factors influencing disaster preparedness and response in healthcare facilities, with emphasis on both organizational readiness (hospital-level) and vulnerability assessment (facility resilience to natural hazards).
Why This Research?
Healthcare organizations face increasing threats from natural and man-made disasters. The frequency of mass casualty incidents (earthquakes, floods, epidemics, etc.) has underscored the need for comprehensive preparedness planning. Most existing research focuses on system-level responses rather than facility-specific and individual responses. This study addresses this gap by assessing disaster preparedness among healthcare facilities in India, integrating organizational capacity with hazard vulnerability assessment.
What Is This Tool?
This combined assessment tool merges two complementary frameworks:
• Organizational-level assessment: Facility infrastructure, human resources, institutional arrangements, disaster management planning, and drills.
• Hazard Risk Assessment: Exposure to natural/environmental hazards, surrounding vulnerabilities, and resilience across five dimensions (physical, human resources, institutional, social, natural).
Who Is Being Invited?
You are invited because your healthcare facility plays a critical role in community disaster response. Whether you are a hospital, primary health center, or community health facility, your participation will help develop evidence-based recommendations for disaster preparedness in Indian healthcare settings.
What Does Participation Involve?
Duration: Approximately 60-90 minutes
Process: A structured questionnaire combining open-ended responses (facility details, observations) and scored indicators (1-5 scale assessing preparedness levels).
Confidentiality: All information is anonymous and strictly confidential. Your facility's identity will not be disclosed. Data will be securely stored and destroyed upon thesis completion or earlier upon request.
Voluntary Nature: You may skip any question, withdraw at any time without penalty, and modify responses during the interview.
Potential Risks
You may feel uncomfortable answering questions about gaps in disaster preparedness or past incidents. However, these assessments are designed to improve preparedness, not to assign blame. All responses are confidential and will not be used for regulatory compliance audits or punitive purposes.
Benefits
• Facility-level: Understand your preparedness strengths and gaps; actionable recommendations for improvement.
• Research-level: Findings will inform national and state disaster management policies and healthcare facility design standards.
• Recognition: Your participation contributes to building a more resilient healthcare system.
You will receive a small token of appreciation upon completion of the assessment.
Confidentiality & Data Protection
All information is treated as confidential and will be kept securely protected. No individual facility will be identifiable in publications or thesis. Data will be:
• Stored on password-protected devices
• Accessed only by research personnel
• Destroyed within one year of thesis completion
• Never shared with external agencies or used for regulatory action
Questions & Further Information
If you have questions now or later:
• Contact Researcher: nidhi@iihmrdelhi.edu.in, nidhiyadav5gmail.com | 9717322240
• Contact Research Guide: IIHMR Delhi
• Ethics Concerns: IRB, IIHMR Delhi
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