Use this form to create a condensed version of your Emergency Action Plan. Provide it to personnel.
Side A contains important contact information, general expectations of personnel, and guidance for evacuating the facility. Side B contains guidance for an earthquake and is set up for you to add instructions for additional scenarios or for the recovery of essential business processes.
Sections that contain contact information have been set up as fill-in fields. Unused fields can be deleted.
For best results, print pages two and three back-to-back on legal-size paper (8 ½” x 14”). Trim on the outside lines. Fold in half lengthwise (long way) and then on the vertical lines, like an accordion.
| Emergency Contacts
Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone |
Enter Name
O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone First Responders Police Department Enter phone Fire Department Enter phone Emergency medical/ambulance service Enter phone Security Enter phone |
Emergency Response Team (ERT)
Enter the ROLE/Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter the ROLE/Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter the ROLE/Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter the ROLE/Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter the ROLE/Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter the ROLE/Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter the ROLE/Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter the ROLE/Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone Enter the ROLE/Name O: Enter office phone / M: Enter mobile phone / H: Enter home phone |
Personnel Expectations
Before an emergency: ● Accept personal responsibility for your own safety and that of your family. ● Prepare your personal/family emergency plan. ● Review your organization’s Emergency Response/Action Plan. ● Know the location of all your building’s exits and assembly areas. ● Know the specific hazards in your area and the response procedures for each hazard. ● Understand how to report an emergency. ● Be familiar with emergency notification methods. ● Find the location of common emergency equipment (e.g., trauma kits, fire alarm pull stations, fire extinguishers, etc.). ● Participate in building and site-wide evacuation drills and exercises. ● Identify your building manager, Fire Wardens, and Emergency Response Team members. During an emergency: All personnel not directly involved in the emergency response are expected to: ● Follow instructions given over a public address system, radio, or directly by a person of authority (e.g., professional first responder, Emergency Response Team members, or Safety/Fire Warden). ● If it is safe to do so, take your personal items with you. ● Report to the nearest assembly area. ● If requested, assist Emergency Response Team members in the performance of their duties. |
After an emergency:
● Do not re-enter the building unless instructed to do so by a person of authority. ● If leaving the assembly area, check with the Emergency Response Team member in charge. Evacuation If the fire alarm sounds, immediately evacuate the building by the nearest safe exit. Leave by nearest exit ● Evacuate the building immediately by the nearest safe exit or as advised by the Emergency Response Team. ● Only if it is safe to do so, gather your personal items quickly. You may not be allowed to re-enter the building for some time. ● Shelter-in-place if instructed to do. Assembly Areas Proceed to the designated assembly area and check in with the Emergency Response Team member in charge. ● REMAIN at the assembly area until released by a person of authority (i.e., professional first responder, Emergency Response Team member, or Safety/Fire Warden). Walk ● Personnel should WALK, not run. Grasp handrails, remain QUIET and CALM, and follow emergency instructions. ● If you meet firefighters coming up, stay next to the outside wall of the stairs in single file. Re-entry Do not re-enter an evacuated building until instructed to do so by a person of authority. |
Fire
If the fire alarm sounds ● Evacuate the building immediately and proceed to the designated Assembly Area. ● Before opening any door, check the door and the door’s handle temperature with the back of your hand. ● Never open doors that are warm to the touch. ● If a door handle is warm, then use an alternate route. ● If smoke, heat, or flames block your exit routes, stay in the room with doors closed. Place a wet towel under the door, if available. ● Open a window and wave a brightly colored cloth or flashlight to signal for help. ● Avoid smoke or fumes. ● If unavoidable, crawl low under smoke. If there is a fire in your workspace ● Activate the nearest fire alarm pull station and alert others in the immediate area. ● Use extinguisher only if trained and comfortable in doing so. ● Always maintain access to an exit. Do not let the fire get between you and the exit. ● Close doors behind you as you exit. ● Evacuate and proceed to the designated Assembly Area. ● DO NOT USE ELEVATORS! ● Do not re-enter the building until it is deemed safe to do so by a person of authority (i.e., professional responder, ERT member, Safety/Fire Warden. |
| Earthquake
DROP Drop to the floor. COVER Seek sturdy overhead protection such as a desk, table, workbench, or corner away from windows. HOLD Hold on to the protection you’ve chosen and be prepared to move with it until the shaking stops. Evacuation post-earthquake ● Take car keys and small personal items. ● Evacuate immediately following shaking. ● Follow Emergency Response Team instructions. ● Do not attempt to re-enter buildings. |
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