96-Hour Sustainability Assessment

Wellstar Windy Hill Hospital · Emergency Preparedness
All-Hazards ScenarioNot yet saved

Readiness Survey Readiness Index

Risk Status Distribution

Rollup Critical Functions — Lowest Sustainability by Category

At-Risk Shortest Sustainability Periods

Capped at 96 h for display · red bars are below the yellow threshold

Action Gap Register — Items Below 96 Hours

Every item here needs a documented mitigation strategy
Method: Average Consumption Rate = (Annual Consumption ÷ 365) × Census Adjustment × Surge Factor, where Census Adjustment = Average Daily Census ÷ Baseline Census. Inventory Sustainability Period (hours) = (Actual Inventory ÷ Average Rate) × 24. Gap = 96 − Sustainability. Non-consumable service/system items are scored with a documented Manual Sustainability Estimate and a stated basis. Framework: Iroquois Healthcare Association / HANYS 96-Hour Sustainability Assessment.

Pre-Planning Resource & Asset Calculator

Set on the Configuration tab · annual ÷ 365
Census the annual figures reflect
Planning multiplier (1.00 = none)
Scenario drives assumptions & report title
Response phase. During an actual incident, record current inventory and current census at each time frame. Estimated Consumption Rate (units/hour) = (Annual ÷ 365 ÷ 24) × (Current Census ÷ Baseline Census) × Surge, reduced by any consumption adjustment you apply. Sustainable Period = Current Inventory ÷ adjusted hourly rate. Time frames follow the HANYS response model: 0–2, 2–12, 12–24, 24–48 and 48–96 hours.

Incident Activation Record

Time Frame Current Census & Command Decisions

Tracking Resource Status by Time Frame

Operations 96-Hour Emergency Operations Impact Chart

Green — Resources known or calculated to be available with no impact on normal operations.
Yellow — Potential impact on normal operations. Implement EOP strategies, conservation measures and resupply requests.
Red — Normal and emergency operations significantly impacted; internal resources and strategies depleted. Consider diversion, partial or total evacuation.
Grey — Not assessed: no consumption data and no documented manual estimate.
CMS §482.15(b)(1)(i) requires policies for the provision of subsistence needs — food, water, medical and pharmaceutical supplies — for staff and patients, whether they evacuate or shelter in place. This module reproduces the facility Emergency Food Plan population model and converts it into 96-hour inventory requirements. Source: eCFR 42 CFR 482.15.

Section I Population to Be Fed

Sections II–IV Meal Plan Assumptions

Section V Required vs. On-Hand Inventory

Emergency Par Tube Feeding, Infant Formula & Supplements

Par List Food & Disposable Inventory by Population Served

Potable Water 96-Hour Water Requirement

Supply Chain Vendor Register

Staffing Suggested Nutrition Services Staffing Plan

Cost Recovery Incident Accounting Log

Verify before survey. Citations below were checked against publicly available Joint Commission and CMS sources on the date shown in each row. Standard numbering changed under Accreditation 360 (effective 1 January 2026): the substance of the Emergency Management elements of performance is unchanged, but some requirements moved to the new National Performance Goals chapter. Confirm each citation against your current e-dition manual and record the check in the review log.

Crosswalk Standard & Regulatory Alignment

Governance Review, Approval & Distribution

Integrity Revision History & Audit Log

Every configuration change, approval and data reset is time-stamped with the operator initials set on the Configuration tab. The log travels with the JSON backup and the cloud payload.

Deliverable Report Builder

Sections to Include

Preview Generated Report

Word export and PDF print use exactly this content
Select your sections and choose Build Report.

Organization Facility Profile

Organizational Logo
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Census Average Daily Census by Unit

Enter annual patient volume by unit; the daily figure is calculated as annual ÷ 365, or enter a daily figure directly and leave annual at zero. The total becomes the Average Daily Census used by every consumption calculation. Unit names can be changed to match how census is defined at your facility.

Census the annual consumption data reflects
Planning multiplier for surge scenarios

Scoring Status Thresholds

Sustainability at or above the green threshold scores Green; between the yellow and green thresholds scores Yellow; below the yellow threshold scores Red. Defaults reflect the 96-hour planning standard with a 48-hour intermediate trigger.

Yellow band width after depletion

Planning Scenario & Assumptions

Surveyors ask what the assessment assumed. Record the conditions applied — utility status, staffing availability, resupply expectations, patient influx.

Multi-Device Cloud Sync

Cloud sync stores an encrypted-in-transit copy of this module's data in your S.E.M.S. cloud endpoint so the assessment can be opened and continued on another computer. Settings are shared with every S.E.M.S. module opened from the same location. Configure the endpoint, then use Backup Now on this computer and Restore on the other.

Conflict handling. This tool uses last-write-wins with a timestamp check. Before editing on a second computer, use Restore Latest to pull the current version; if the cloud copy is newer than your local copy, a warning is shown rather than silently overwriting either side. Only one person should edit a given facility record at a time.

Data Local Storage & Backup

Source & Method Statement

Framework: Iroquois Healthcare Association / Healthcare Association of New York State (HANYS) 96-Hour Sustainability Assessment, referenced by ASPR TRACIE. Resource list, critical function categories and the emergency food model are pre-loaded from the facility's 96-Hour Sustainability Chart workbook and Emergency Food Plan workbook. Calculations run entirely in this browser; nothing is transmitted unless cloud sync is configured and used.