Emergency Action Plan (Template)

EMERGENCY ACTION PLAN

for

Facility Name:
____________________

Facility Address:
___________________






DATE PREPARED: ___/_____/______

EMERGENCY PERSONNEL NAMES AND PHONE
NUMBERS

DESIGNATED RESPONSIBE OFFICIA !"i#$est Ra%&i%# 'a%a#er at
_____________site( s)c$ as __________( ___________( or ____________*:

Name: P$o%e:
!________________*

EMERGENCY COORDINATOR:
Name: P$o%e:
!______________*
AREA/FOOR 'ONITORS !If a++lica,le*:
Area/Floor: Name: P$o%e:
!_______________*
Area/Floor: Name: P$o%e:
!_______________*
ASSISTANTS TO P"-SICA- C"AENGED !If a++lica,le*:
Name: P$o%e: !_______________*

Name: P$o%e:
!________________*





Date ____/____/____



EACUA!"ON ROU!ES
# E.ac)atio% ro)te ma+s $a.e ,ee% +osted i% eac$ /or& area0 T$e
follo/i%# i%formatio% is mar&ed o% e.ac)atio% ma+s:
1. Emergency exits
2. Primary and secondary evacuation routes
3. Locations of fire extinguishers
4. Fire alarm pull stations location
a. Assemly points
! "ite personnel should #no$ at least t$o evacuation routes.


EMERGENCY PHONE NUMBERS

FIRE DEPART'ENT:
________________

PARA'EDICS:
_______________

A'B1ANCE:
_______________

POICE:
________________

FEDERA PROTECTI2E SER2ICE:
________________
SEC1RIT- !If a++lica,le*:
_________________

B1IDING 'ANAGER !If a++lica,le*:
________________












U!"L"!Y COMPANY EMERGENCY CON!AC!S
!S+ecify %ame of t$e com+a%y( +$o%e %)m,er a%d +oi%t of co%tact*
ELEC!R"C:
_____________________




$A!ER:
_______________________




GAS (i% a&&lica'le)(
__________________________




!ELEPHONE COMPANY(
_______________________




Date: ___/____/_____

EMERGENCY REPOR!"NG AND EACUA!"ON
PROCEDURES
Ty+es of emer#e%cies to ,e re+orted ,y site +erso%%el are:
3 'EDICA
3 FIRE
3 SE2ERE 4EAT"ER
3 BO'B T"REAT
3 C"E'ICA SPI
3 STR1CT1RE CI'BING/DESCENDING
3 E5TENDED PO4ER OSS
3 OT"ER !s+ecify*___________________________________
!e0#0( terrorist attac&/$osta#e ta&i%#*


MED"CAL EMERGENCY
3 Call medical emergency +$o%e %)m,er !c$ec& a++lica,le*:
Paramedics
Am,)la%ce
Fire De+artme%t
Ot$er

Pro.ide t$e follo/i%# i%formatio%:
a0 Nat)re of medical emergency(
,0 ocatio% of t$e emergency !address( ,)ildi%#( room
%)m,er*( a%d
c0 -o)r %ame a%d +$o%e %)m,er from /$ic$ yo) are calli%#0
3 Do %ot mo.e .ictim )%less a,sol)tely %ecessary0
3 Call t$e follo/i%# +erso%%el trai%ed i% CPR a%d First Aid to
+ro.ide t$e re6)ired assista%ce +rior to t$e arri.al of t$e
+rofessio%al medical $el+:
Name:
P$o%e:_______________________
Name: P$o%e:
________________________
3 If +erso%%el trai%ed i% First Aid are %ot a.aila,le( as a mi%im)m(
attem+t to +ro.ide t$e follo/i%# assista%ce:
%. "top the leeding $ith firm pressure on the $ounds &note'
avoid contact $ith lood or other odily fluids(.
). *lear the air passages using the +eimlich ,aneuver in case
of cho#ing.
! -n case of rendering assistance to personnel exposed to ha.ardous
materials/ consult the ,aterial "afety 0ata "heet &,"0"( and $ear the
appropriate personal protective e1uipment. Attempt first aid 23L4 if
trained and 1ualified.


0ate55565556555

)"RE EMERGENCY
When fire is discovered:
3 Acti.ate t$e %earest fire alarm !if i%stalled*
3 Notify t$e local Fire De+artme%t ,y calli%#
0
3 If t$e fire alarm is %ot a.aila,le( %otify t$e site +erso%%el a,o)t t$e
fire emergency ,y t$e follo/i%# mea%s !c$ec& a++lica,le*:

2oice Comm)%icatio%
P$o%e Pa#i%#


Radio
Ot$er !s+ecify*

Fight the fire ONLY if:

3 T$e Fire De+artme%t $as ,ee% %otified0
3 T$e fire is small a%d is %ot s+readi%# to ot$er areas0
3 Esca+i%# t$e area is +ossi,le ,y ,ac&i%# )+ to t$e %earest e7it0
3 T$e fire e7ti%#)is$er is i% /or&i%# co%ditio% a%d +erso%%el are
trai%ed to )se it0
Upon being notified about the fire emergency, occupants must:
3 ea.e t$e ,)ildi%# )si%# t$e desi#%ated esca+e ro)tes0
3 Assem,le i% t$e desi#%ated area !s+ecify locatio%*:

3 Remai% o)tside )%til t$e com+ete%t a)t$ority !Desi#%ated Official
or desi#%ee* a%%o)%ces t$at it is safe to ree%ter0
Designated Official, Emergency Coordinator or supervisors must
underline one!:
3 Disco%%ect )tilities a%d e6)i+me%t )%less doi%# so 8eo+ardi9es
$is/$er safety0
3 Coordi%ate a% orderly e.ac)atio% of +erso%%el0
3 Perform a% acc)rate $ead co)%t of +erso%%el re+orted to t$e
desi#%ated area0
3 Determi%e a resc)e met$od to locate missi%# +erso%%el0
3 Pro.ide t$e Fire De+artme%t +erso%%el /it$ t$e %ecessary
i%formatio% a,o)t t$e facility0
3 Perform assessme%t a%d coordi%ate /eat$er forecast office
emergency closi%# +roced)res
"rea#Floor $onitors must:
3 E%s)re t$at all em+loyees $a.e e.ac)ated t$e area/floor0
3 Re+ort a%y +ro,lems to t$e Emergency Coordi%ator at t$e
assem,ly area0
"ssistants to %h&sicall& Challenged should:
3 Assist all +$ysically c$alle%#ed em+loyees i% emergency
e.ac)atio%0
Date___/___/___


E*!ENDED PO$ER LOSS
I% t$e e.e%t of e7te%ded +o/er loss to a facility certai% +reca)tio%ary meas)res
s$o)ld ,e ta&e% de+e%di%# o% t$e #eo#ra+$ical locatio% a%d e%.iro%me%t of t$e
facility:
o 1%%ecessary electrical e6)i+me%t a%d a++lia%ces s$o)ld ,e t)r%ed
off i% t$e e.e%t t$at +o/er restoratio% /o)ld s)r#e ca)si%# dama#e
to electro%ics a%d effecti%# se%siti.e e6)i+me%t0
o Facilities /it$ free9i%# tem+erat)res s$o)ld t)r% off a%d drai% t$e
follo/i%# li%es i% t$e e.e%t of a lo%# term +o/er loss0
Fire s+ri%&ler system
Sta%d+i+es
Pota,le /ater li%es
Toilets
o Add +ro+yle%e:#lycol to drai%s to +re.e%t tra+s from free9i%#
o E6)i+me%t t$at co%tai% fl)ids t$at may free9e d)e to lo%# term
e7+os)re to free9i%# tem+erat)res s$o)ld ,e mo.ed to $eated
areas( drai%ed of li6)ids( or +ro.ided /it$ a)7iliary $eat so)rces0

1+o% Restoratio% of $eat a%d +o/er:
o Electro%ic e6)i+me%t s$o)ld ,e ,ro)#$t )+ to am,ie%t
tem+erat)res ,efore e%er#i9i%# to +re.e%t co%de%sate from formi%#
o% circ)itry0
o Fire a%d +ota,le /ater +i+i%# s$o)ld ,e c$ec&ed for lea&s from
free9e dama#e after t$e $eat $as ,ee% restored to t$e facility a%d
/ater t)r%ed ,ac& o%0
o
CHEM"CAL SP"LL
T$e follo/i%# are t$e locatio%s of:
S+ill Co%tai%me%t a%d Sec)rity E6)i+me%t: ___________________________
Perso%al Protecti.e E6)i+me%t !PPE*:
'SDS:_____________________________________________________
When a Large Chemical 'pill has occurred:
3 Immediately %otify t$e desi#%ated official a%d Emergency
Coordi%ator0
3 Co%tai% t$e s+ill /it$ a.aila,le e6)i+me%t !e0#0( +ads( ,ooms(
a,sor,e%t +o/der( etc0*0
3 Sec)re t$e area a%d alert ot$er site +erso%%el0
3 Do %ot attem+t to clea% t$e s+ill )%less trai%ed to do so0
3 Atte%d to i%8)red +erso%%el a%d call t$e medical
emergency %)m,er( if re6)ired0
3 Call a local s+ill clea%)+ com+a%y or t$e Fire De+artme%t !if
arra%#eme%t $as ,ee% made* to +erform a lar#e c$emical !e0#0(
merc)ry* s+ill clea%)+0
Name of S+ill Clea%)+ Com+a%y:_______________________________
P$o%e N)m,er:_____________________________________________
3 E.ac)ate ,)ildi%# as %ecessary
When a 'mall Chemical 'pill has occurred:
3 Notify t$e Emergency Coordi%ator a%d/or s)+er.isor !select
o%e*0
3 If to7ic f)mes are +rese%t( sec)re t$e area !/it$ ca)tio% ta+es or
co%es* to +re.e%t ot$er +erso%%el from e%teri%#0
3 Deal /it$ t$e s+ill i% accorda%ce /it$ t$e i%str)ctio%s
descri,ed i% t$e 'SDS0
3 Small s+ills m)st ,e $a%dled i% a safe ma%%er( /$ile /eari%# t$e
+ro+er PPE0
3 Re.ie/ t$e #e%eral s+ill clea%)+ +roced)res0

Date___/___/___

S!RUC!URE CL"MB"NG+DESCEND"NG EMERGENC"ES
ist str)ct)res mai%tai%ed ,y site +erso%%el !to/er( ri.er #a)#e( etc0*:

No0 Str)ct)re
Ty+e
ocatio% !address( if
a++lica,le*
Emergency Re,&on,e Or#a%i9atio%; !if a.aila,le
/it$i% <=:mi%)te re,&on,e time*









































Emergency Re,&on,e Or#a%i9atio%!s*:
Name P$o%e
N)m,er______________________
Name P$o%e N)m,er______________________

!Attac$ Emergency Re,&on,e A#reeme%t if a.aila,le*

; : N/A0 If %o Emergency Re,&on,e Or#a%i9atio% a.aila,le /it$i% <=:
mi%)te re,&on,e time additio%al +erso%%el trai%ed i% resc)e o+eratio%s
a%d e6)i++ed /it$ resc)e &it m)st accom+a%y t$e clim,er!s*0

!ELEPHONE BOMB !HREA! CHEC-L"S!
INSTR1CTIONS: BE CA'( BE CO1RTEO1S0 ISTEN0 DO NOT INTERR1PT T"E CAER0
-O1R NA'E: __________________________ TI'E: _____________ DATE:
________________
CAER>S IDENTIT- SE5: 'ale _____ Female ____ Ad)lt ____ ?).e%ile ____
APPRO5I'ATE AGE: _____
ORIGIN OF CA: ocal __________ o%# Dista%ce ___________ Tele+$o%e Boot$
__________

2OICE C"ARACTERISTICS

SPEEC"

ANG1AGE

___ o)d
___ "i#$ Pitc$
___ Ras+y
___ I%to7icated

___ Soft
___ Dee+
___ Pleasa%t
____________
Ot$er

___ Fast
___ Disti%ct
___ St)tter
___ Sl)rred

___ Slo/
___ Distorted
___ Nasal
____________
Ot$er

___ E7celle%t
___ Fair
___ Fo)l

___ Good
___ Poor
__________
Ot$er

ACCENT

'ANNER

BAC@GRO1ND NOISES

___ ocal
___ Forei#%
___ Race

___ Not ocal
___ Re#io%

___ Calm
___ Ratio%al
___ Co$ere%t
___ Deli,erate
___ Ri#$teo)s

___ A%#ry
___ Irratio%al
___ I%co$ere%t
___ Emotio%al
___ a)#$i%#

___ Factory
___ 'ac$i%es
___ ')sic
___ Office
___ 'ac$i%es
___ Street
___ Traffic

___ Trai%s
___ A%imals
___ A)iet
___ 2oices
___ Air+la%es
___ Party
___ Atmos+$ere

BO'B FACTS
PRETEND DIFFIC1T- "EARING : @EEP CAER TA@ING : IF CAER
SEE'S AGREEABE TO F1RT"ER CON2ERSATION( AS@ A1ESTIONS
I@E:
4$e% /ill it #o offB Certai% "o)r ____ Time Remai%i%#
4$ere is it locatedB B)ildi%# Area
4$at &i%d of ,om,B ___________________

4$at &i%d of +ac&a#eB______________

"o/ do yo) &%o/ so m)c$ a,o)t t$e ,om,B
___
4$at is yo)r %ame a%d addressB

If ,)ildi%# is occ)+ied( i%form caller t$at deto%atio% co)ld ca)se i%8)ry or deat$0
Acti.ate malicio)s call trace: "a%# )+ +$o%e a%d do %ot a%s/er a%ot$er li%e0
C$oose same li%e a%d dial ;CD !if yo)r +$o%e system $as t$is ca+a,ility*0 iste%
for t$e co%firmatio% a%%o)%ceme%t a%d $a%# )+0
Call Sec)rity at __________ a%d relay i%formatio% a,o)t call.
Did t$e caller a++ear familiar /it$ +la%t or ,)ildi%# !,y $is/$er descri+tio% of t$e
,om, locatio%*B 4rite o)t t$e messa#e i% its e%tirety a%d a%y ot$er comme%ts o%
a se+arate s$eet of +a+er a%d attac$ to t$is c$ec&list0
Notify yo)r s)+er.isor immediately0

SEERE $EA!HER AND NA!URAL D"SAS!ERS
Tornado:
3 4$e% a /ar%i%# is iss)ed ,y sire%s or ot$er mea%s( see& i%side
s$elter0 Co%sider t$e follo/i%#:
: Small i%terior rooms o% t$e lo/est floor a%d /it$o)t
/i%do/s(
: "all/ays o% t$e lo/est floor a/ay from doors a%d
/i%do/s( a%d
: Rooms co%str)cted /it$ rei%forced co%crete( ,ric&( or
,loc& /it$ %o /i%do/s0
3 Stay a/ay from o)tside /alls a%d /i%do/s0
3 1se arms to +rotect $ead a%d %ec&0
3 Remai% s$eltered )%til t$e tor%ado t$reat is a%%o)%ced to ,e o.er0
Earthquake:
3 Stay calm a%d a/ait i%str)ctio%s from t$e Emergency
Coordi%ator or t$e desi#%ated official0
3 @ee+ a/ay from o.er$ead fi7t)res( /i%do/s( fili%# ca,i%ets( a%d
electrical +o/er0
3 Assist +eo+le /it$ disa,ilities i% fi%di%# a safe +lace0
3 E.ac)ate as i%str)cted ,y t$e Emergency Coordi%ator a%d/or t$e
desi#%ated official0
Flood:
(f indoors:
3 Be ready to e.ac)ate as directed ,y t$e Emergency Coordi%ator
a%d/or t$e desi#%ated official0
3 Follo/ t$e recomme%ded +rimary or seco%dary e.ac)atio% ro)tes0
(f outdoors:
3 Clim, to $i#$ #ro)%d a%d stay t$ere0
3 A.oid /al&i%# or dri.i%# t$ro)#$ flood /ater0
3 If car stalls( a,a%do% it immediately a%d clim, to a $i#$er #ro)%d0
Hurricane:
3 T$e %at)re of a $)rrica%e +ro.ides for more /ar%i%# t$a% ot$er
%at)ral a%d /eat$er disasters0 A $)rrica%e /atc$ iss)ed /$e% a
$)rrica%e ,ecomes a t$reat to a coastal area0 A $)rrica%e /ar%i%#
is iss)ed /$e% $)rrica%e /i%ds of DE m+$ or $i#$er( or a
com,i%atio% of da%#ero)sly $i#$ /ater a%d ro)#$ seas( are
e7+ected i% t$e area /it$i% FE $o)rs0
Once a hurricane )atch has been issued:
3 Stay calm a%d a/ait i%str)ctio%s from t$e
Emergency Coordi%ator or t$e desi#%ated
official0
3 'oor a%y
,oats
sec)rely( or
mo.e to a
safe +lace if
time allo/s0
3 Co%ti%)e to mo%itor local T2 a%d radio statio%s for i%str)ctio%s0
3 'o.e early o)t of lo/:lyi%# areas or from t$e coast( at t$e re6)est
of officials0
3 If yo) are o% $i#$ #ro)%d( a/ay from t$e coast a%d &lan to stay(
sec)re t$e ,)ildi%#( mo.i%# all loose items i%doors a%d ,oardi%# )+
/i%do/s a%d o+e%i%#s*
3 Collect dri%&i%# /ater i% a++ro+riate co%tai%ers0
Once a hurricane )arning has been issued:
3 Be ready to e.ac)ate as directed ,y t$e Emergency Coordi%ator
a%d/or t$e desi#%ated official0
3 ea.e areas t$at mi#$t ,e affected ,y storm tide or stream
floodi%#0
During a hurricane:
3 Remai% i%doors a%d co%sider t$e follo/i%#:
: Small i%terior rooms o% t$e lo/est floor a%d /it$o)t
/i%do/s(
: "all/ays o% t$e lo/est floor a/ay from doors a%d
/i%do/s( a%d
: Rooms co%str)cted /it$ rei%forced co%crete( ,ric&( or
,loc& /it$ %o /i%do/s0
Blizzard:
(f indoors:
3 Stay calm a%d a/ait i%str)ctio%s from t$e Emergency
Coordi%ator or t$e desi#%ated official0
3 Stay i%doorsG
3 If t$ere is %o $eat:
: Close off )%%eeded rooms or areas0
: St)ff to/els or ra#s i% crac&s )%der doors0
: Co.er /i%do/s at %i#$t0
3 Eat a%d dri%&0 Food +ro.ides t$e ,ody /it$ e%er#y a%d $eat0
Fl)ids +re.e%t de$ydratio%0
3 4ear layers of loose:fitti%#( li#$t:/ei#$t( /arm clot$i%#( if
a.aila,le0
(f outdoors:
3 Fi%d a dry s$elter0 Co.er all e7+osed +arts of t$e ,ody0
3 If s$elter is %ot a.aila,le:
: Pre+are a lea%:to( /i%d ,rea&( or s%o/ ca.e for +rotectio%
from t$e /i%d0
: B)ild a fire for $eat a%d to attract atte%tio%0 Place roc&s
aro)%d t$e fire to a,sor, a%d reflect $eat0
: Do %ot eat s%o/0 It /ill lo/er yo)r ,ody tem+erat)re0 'elt
it first0
(f stranded in a car or truc+:
3 Stay i% t$e .e$icleG
3 R)% t$e motor a,o)t te% mi%)tes eac$ $o)r0
O+e% t$e /i%do/s a little for fres$ air to a.oid
car,o% mo%o7ide +oiso%i%#0 'a&e s)re t$e
e7$a)st +i+e is %ot ,loc&ed0
3 'a&e yo)rself .isi,le to resc)ers0
: T)r% o% t$e dome li#$t at %i#$t /$e% r)%%i%# t$e e%#i%e0
: Tie a colored clot$ to yo)r a%te%%a or door0
: Raise t$e $ood after t$e s%o/ sto+s falli%#0
3 E7ercise to &ee+ ,lood circ)lati%# a%d to &ee+ /arm0




CR"!"CAL OPERA!"ONS
D)ri%# some emergency sit)atio%s( it /ill ,e %ecessary for some s+ecially
assi#%ed +erso%%el to remai% at t$e /or& areas to +erform critical o+eratio%s0
Assi#%me%ts:
4or&
Area Name ?o,
Title Descri+tio% of
Assi#%me%t




3 Perso%%el i%.ol.ed i% critical o+eratio%s may remai% o% t$e site
)+o% t$e +ermissio% of t$e site desi#%ated official or Emergency
Coordi%ator0
3 I% case emergency sit)atio% /ill %ot +ermit a%y of t$e +erso%%el
to remai% at t$e facility( t$e desi#%ated official or ot$er assi#%ed
+erso%%el s$all %otify t$e a++ro+riate _______________ offices to
i%itiate ,ac&)+s0 T$is i%formatio% ca% ,e o,tai%ed from t$e
Emergency E.ac)atio% Proced)res i%cl)ded i% t$e
___________________ 'a%)al0
T$e follo/i%# offices s$o)ld ,e co%tacted:
Name/ocatio%:________________________________
Tele+$o%e N)m,er:_____________________________
Name/ocatio%:________________________________
Tele+$o%e N)m,er:_____________________________
Name/ocatio%:________________________________
Tele+$o%e N)m,er:_____________________________

!RA"N"NG
T$e follo/i%# +erso%%el $a.e ,ee% trai%ed to e%s)re a safe a%d orderly
emergency e.ac)atio% of ot$er em+loyees:
Facility:
Name Title
Res+o%si,ilit
y Date