Emergency Action Plan

EMERGENCY PERSONNEL NAMES AND PHONE NUMBERS
Designated Responsible Official

Name

Contact Number

Emergency Coordinator

Name

Contact Number

Are area/floor monitors applicable?

Monitor

Area/Floor

Name

Contact Number

Are assistants to physically challenged applicable?

Assistant

Name

Contact Number

EMERGENCY REPORTING AND EVACUATION PROCEDURES
Select type(s) of emergency to be reported by site personnel

Specify

MEDICAL EMERGENCY

Call medical emergency phone number

Select all that applies

Specify

Provide the nature of the medical emergency

Provide the location of the emergency (address, building, floor, etc.)

Provide your name and phone number from which you are calling

Do not move the victim unless absolutely necessary

Is personnel trained in CPR and First Aid available?

Personnel

Name

Contact Number

Stop the bleeding with firm pressure on the wounds.

Note: avoid contact with blood or other bodily fluids.

Clear the air passages using the Heimlich Maneuver in case of choking.

Is the medical emergency a case of rendering assistance to personnel exposed to hazardous materials?

Consult the Material Safety Data Sheet (MSDS).

Wear the appropriate personal protective equipment.

Attempt first aid only if trained and qualified.

FIRE EMERGENCY

Is the fire alarm available?

Activate the nearest fire alarm.

Call an notify the local Fire Department.

Notify the site personnel about the fire emergency.

Select all that applies

Specify

Fight the fire only if the Fire Department has been notified.

Fight the fire only if the fire is small and is not spreading to other areas.

Fight the fire only if escaping the area is possible by backing up to the nearest exit.

Fight the fire only if the fire extinguisher is in working condition and personnel are trained to
use it.

Upon being notified about the fire emergency, employees must leave the building using the designated escape routes.

Upon being notified about the fire emergency, employees must assemble in the designated area.

Designated Area Location

Upon being notified about the fire emergency, employees must remain outside until the designated responsible official announces that it is safe to reenter.

The designated responsible official or emergency coordinator must disconnect utilities and equipment unless doing so jeopardizes his/her safety.

The designated responsible official or emergency coordinator must coordinate an orderly evacuation of personnel.

The designated responsible official or emergency coordinator must perform an accurate headcount of personnel reported to the designated area.

The designated responsible official or emergency coordinator must determine a rescue method to locate missing personnel.

The designated responsible official or emergency coordinator must provide the Fire Department personnel with the necessary information about the facility.

The designated responsible official or emergency coordinator must perform assessment and coordinate weather forecast office emergency closing procedures.

Area/Floor Monitors must ensure that all employees have evacuated the area/floor.

Area/Floor Monitors must report any problems to the emergency coordinator at the assembly area.

Assistants to the physically challenged should assist all physically challenged employees in an emergency evacuation.

SEVERE WEATHER AND NATURAL DISASTERS
Select type(s) of severe weather or natural disaster
TORNADO

When a warning is issued by sirens or other means, seek inside shelter.

Consider small interior rooms on the lowest floor and without windows.

Consider hallways on the lowest floor away from doors and windows.

Consider rooms constructed with reinforced concrete, brick, or block with no windows.

Stay away from outside walls and windows.

Use arms to protect head and neck.

Remain sheltered until the tornado threat is announced to be over.

EARTHQUAKE

Stay calm and await instructions from the designated responsible official or the emergency coordinator.

Keep away from overhead fixtures, windows, filing cabinets, and electrical power.

Assist people with disabilities in finding a safe place.

Evacuate as instructed by the designated responsible official or the emergency coordinator.

FLOOD
Where?
INDOORS

Be ready to evacuate as directed by the designated responsible official or the emergency coordinator.

Follow the recommended primary or secondary evacuation routes.

OUTDOORS

Climb to high ground and stay there.

Avoid walking or driving through flood water.

If car stalls, abandon it immediately and climb to a higher ground.
HURRICANE
When?
Once a hurricane watch has been issued

Stay calm and await instructions from the designated responsible official or the emergency coordinator.

Moor any boats securely, or move to a safe place if time allows.

Continue to monitor local TV and radio stations for instructions.

Move early out of low-lying areas or from the coast, at the request of officials.

Collect drinking water in appropriate containers.

If you are on high ground, away from the coast and plan to stay, secure the building, moving all loose items indoors and boarding up windows and openings.

Once a hurricane warning has been issued

Be ready to evacuate as directed by the designated responsible official or the emergency coordinator.

Leave areas that might be affected by storm tide or stream flooding.

During a hurricane

Remain indoors.

Consider small interior rooms on the lowest floor and without windows.

Consider hallways on the lowest floor away from doors and windows.

Consider rooms constructed with reinforced concrete, brick, or block with no windows.

BLIZZARD
Where?
INDOORS

Stay calm and await instructions from the designated responsible official or the emergency coordinator.

Stay indoors.

Is there no heat?

Close off unneeded rooms or areas.

Stuff towels or rags in cracks under doors.

Cover windows at night.

Eat and drink.

Food provides the body with energy and heat. Fluids prevent dehydration.

Wear layers of loose-fitting, light-weight, warm clothing, if available.

OUTDOORS

Find a dry shelter.

Cover all exposed parts of the body.

If shelter is not available, prepare a lean-to, windbreak, or snow cave for protection from the wind.

Build a fire for heat and to attract attention.

Place rocks around the fire to absorb and reflect heat.

Do not eat snow because it will lower your body temperature. Melt it first.

STRANDED IN A CAR OR TRUCK

Stay in the vehicle.

Run the motor about ten minutes each hour.

Open the windows a little for fresh air to avoid carbon monoxide poisoning.

Make sure the exhaust pipe is not blocked.

Make yourself visible to rescuers.

Turn on the dome light at night when running the engine.

Tie a colored cloth to your antenna or door.

Raise the hood after the snow stops falling.

Exercise to keep blood circulating and to keep warm.

BOMB THREAT

Be calm.

Be courteous.

Listen.

Caller's Identity Sex

Approximate Age

Origin of Call

Voice Characteristics

Specify

Speech

Specify

Language

Specify

Accent
Manner
Background Noises

Do not interrupt the caller.

Pretend difficulty in hearing the caller so he/she keeps talking.

Is the caller agreeable to further conversation?

Certain hour the bomb will go off

Time remaining until the bomb will go off

Which building is the bomb located?

Which area of the building is the bomb located?

What kind of bomb is it?

What kind of package is the bomb in?

How does the caller know so much about the bomb?

What is the caller's name and address?

If the building is occupied, inform the caller that detonation could cause injury or death.

Activate malicious call trace.

Hang up phone and do not answer another line.

Choose the same line and dial *57 (if your phone system has this capability).

Listen for the confirmation announcement and hang up.

Call security and relay information about the call.

Security Contact Number

Did the caller appear familiar with the plant or building (by his/her description of the bomb location)?

The message in its entirety and any other comments

Notify the designated responsible official or emergency coordinator immediately.

CHEMICAL SPILL
Spill Containment and Security Equipment Location
Personal Protective Equipment (PPE) Location
Material Safety Data Sheet (MSDS) Location

Spill Type

When a Large Chemical Spill has occurred

Immediately notify the designated responsible official and the emergency coordinator.

Contain the spill with available equipment (e.g., pads, booms, absorbent powder, etc.)

Secure the area and alert other site personnel.

Do not attempt to clean the spill unless trained to do so.

Attend to injured personnel and call the medical emergency number, if required.

Call a local spill cleanup company or the Fire Department (if arrangement has been made) to perform a large chemical (e.g., mercury) spill cleanup.

Name of Spill Cleanup Company

Contact Number

Evacuate building as necessary

When a Small Chemical Spill has occurred

Notify the designated responsible official or the emergency coordinator.

If toxic fumes are present, secure the area (with caution tapes or cones) to prevent other personnel from entering.

Deal with the spill in accordance with the instructions described in the MSDS.

Small spills must be handled in a safe manner, while wearing the proper PPE.

Review the general spill cleanup procedures.

STRUCTURE CLIMBING/DESCENDING EMERGENCIES
Structure maintained by site personnel

Structure Type

Location (address, if applicable)

Emergency Response Organization (if available within 30-minute response time)

Emergency Response Organization Contact Number

EXTENDED POWER LOSS

Unnecessary electrical equipment and appliances should be turned off in the event that power restoration would surge causing damage to electronics and affecting sensitive equipment.

Facilities with freezing temperatures should turn off and drain the fire sprinkler system in the event of a long term power loss.

Turn off and drain the standpipes in the event of a long term power loss.

Turn off and drain the potable water lines in the event of a long term power loss.

Turn off and drain the toilets in the even of a long term power loss.

Add propylene-glycol to drains to prevent traps from freezing.

Equipment that contain fluids that may freeze due to long term exposure to freezing temperatures should be moved to heated areas, drained of liquids, or provided with auxiliary heat sources.

Upon restoration of heat and power, electronic equipment should be brought up to ambient temperatures before energizing to prevent condensate from forming on circuitry.

Fire and potable water piping should be checked for leaks from freeze damage after the heat has been restored to the facility and water turned back on.

Is there personnel necessary to remain at their work areas to perform critical operations?

CRITICAL OPERATIONS
Specially Assigned Personnel

Work Area

Name

Job Title

Description of Assignment

Remain on the site upon the permission of the site designated responsible official or emergency coordinator.

In case the emergency situation will not permit any of the personnel to remain at the facility, the designated responsible official should notify the appropriate offices to initiate backups.

Office Name/Location

Contact Number

TRAINING

Personnel have been trained to ensure a safe and orderly emergency evacuation of other employees.

Trained Personnel

Name

Title

Responsibility

Training Date
EMERGENCY PHONE NUMBERS

Fire Department

Paramedics

Ambulance

Police

Federal Protective Service

Security (if applicable)

Building Manager (if applicable)

UTILITY COMPANY EMERGENCY CONTACTS
Electric

Name of the Company

Phone Number

Point of Contact

Water

Name of the Company

Phone Number

Point of Contact

Telephone

Name of the Company

Phone Number

Point of Contact

SIGN OFF

Additional Observations

Designated Responsible Official Name & Signature
Emergency Coordinator Name & Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.