Emergency Event Reporting Form

Fill out a report of a Site Emergency to WYPCA

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For a Wyoming HRSA-funded Health Center (FQHC or Look-Alike), the agencies to notify depend on the type of emergency. HRSA does not require every emergency to be reported to every agency. Instead, reporting is based on operational impact, regulatory requirements, and the type of incident.

 

Agency When to Notify Typical Trigger
Wyoming Primary Care Association (WYPCA) Yes Any significant operational disruption affecting patient care, clinic operations, or access to services. WYPCA serves as HRSA’s statewide partner for situational awareness.
Wyoming Department of Health (WDH) When applicable Reportable disease outbreaks, public health emergencies, vaccine issues, or events affecting state-funded programs.
Wyoming Office of Homeland Security (WOHS) When applicable Major disasters, emergency resource requests, or activation of state emergency management. Usually coordinated through the local emergency management agency.
County Emergency Management Agency (EMA) Yes, when local response is needed Facility damage, evacuation, utility failures, severe weather, or incidents requiring local emergency coordination.
Local Public Health Department When applicable Disease outbreaks, environmental health concerns, or community public health response.
CMS (if certified services are affected) As required Events affecting Conditions of Participation or certified services. This is typically coordinated through the state survey agency.
State Licensing/Regulatory Agencies When applicable Incidents involving licensed facilities or services, depending on Wyoming regulations.
Law Enforcement When applicable Criminal activity, threats, workplace violence, theft, or security incidents.
Fire Department When applicable Fire, hazardous materials, evacuation, or life-safety emergencies.
Utility Providers As needed Power, water, gas, telecommunications, or internet outages.
Cyber Insurance Carrier / FBI / CISA For significant cyber incidents Ransomware, major data breaches, or cyberattacks affecting operations.
Malpractice and Property Insurance Carriers As required Property damage, liability events, or business interruption claims.