Title Page
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Facility Name
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Facility Address
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Prepared by
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Date prepared
Emergency Action Plan
EMERGENCY PERSONNEL NAMES AND PHONE NUMBERS
Designated Responsible Official
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Name
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Contact Number
Emergency Coordinator
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Name
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Contact Number
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Are area/floor monitors applicable?
Monitor
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Area/Floor
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Name
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Contact Number
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Are assistants to physically challenged applicable?
Assistant
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Name
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Contact Number
EMERGENCY REPORTING AND EVACUATION PROCEDURES
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Select type(s) of emergency to be reported by site personnel
- Medical
- Fire
- Severe Weather
- Bomb Threat
- Chemical Spill
- Structure Climbing/Descending
- Extended Power Loss
- Other (e.g. terrorist attack/hostage taking)
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Specify
MEDICAL EMERGENCY
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Call medical emergency phone number
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Select all that applies
- Paramedics
- Ambulance
- Fire Department
- Other
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Specify
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Provide the nature of the medical emergency
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Provide the location of the emergency (address, building, floor, etc.)
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Provide your name and phone number from which you are calling
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Do not move the victim unless absolutely necessary
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Is personnel trained in CPR and First Aid available?
Personnel
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Name
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Contact Number
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Stop the bleeding with firm pressure on the wounds.
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Note: avoid contact with blood or other bodily fluids.
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Clear the air passages using the Heimlich Maneuver in case of choking.
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Is the medical emergency a case of rendering assistance to personnel exposed to hazardous materials?
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Consult the Material Safety Data Sheet (MSDS).
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Wear the appropriate personal protective equipment.
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Attempt first aid only if trained and qualified.
FIRE EMERGENCY
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Is the fire alarm available?
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Activate the nearest fire alarm.
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Call an notify the local Fire Department.
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Notify the site personnel about the fire emergency.
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Select all that applies
- Voice Communication
- Phone Paging
- Radio
- Other
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Specify
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Fight the fire only if the Fire Department has been notified.
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Fight the fire only if the fire is small and is not spreading to other areas.
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Fight the fire only if escaping the area is possible by backing up to the nearest exit.
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Fight the fire only if the fire extinguisher is in working condition and personnel are trained to<br>use it.
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Upon being notified about the fire emergency, employees must leave the building using the designated escape routes.
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Upon being notified about the fire emergency, employees must assemble in the designated area.
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Designated Area Location
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Upon being notified about the fire emergency, employees must remain outside until the designated responsible official announces that it is safe to reenter.
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The designated responsible official or emergency coordinator must disconnect utilities and equipment unless doing so jeopardizes his/her safety.
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The designated responsible official or emergency coordinator must coordinate an orderly evacuation of personnel.
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The designated responsible official or emergency coordinator must perform an accurate headcount of personnel reported to the designated area.
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The designated responsible official or emergency coordinator must determine a rescue method to locate missing personnel.
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The designated responsible official or emergency coordinator must provide the Fire Department personnel with the necessary information about the facility.
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The designated responsible official or emergency coordinator must perform assessment and coordinate weather forecast office emergency closing procedures.
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Area/Floor Monitors must ensure that all employees have evacuated the area/floor.
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Area/Floor Monitors must report any problems to the emergency coordinator at the assembly area.
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Assistants to the physically challenged should assist all physically challenged employees in an emergency evacuation.
SEVERE WEATHER AND NATURAL DISASTERS
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Select type(s) of severe weather or natural disaster
- Tornado
- Earthquake
- Flood
- Hurricane
- Blizzard
TORNADO
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When a warning is issued by sirens or other means, seek inside shelter.
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Consider small interior rooms on the lowest floor and without windows.
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Consider hallways on the lowest floor away from doors and windows.
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Consider rooms constructed with reinforced concrete, brick, or block with no windows.
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Stay away from outside walls and windows.
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Use arms to protect head and neck.
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Remain sheltered until the tornado threat is announced to be over.
EARTHQUAKE
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Stay calm and await instructions from the designated responsible official or the emergency coordinator.
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Keep away from overhead fixtures, windows, filing cabinets, and electrical power.
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Assist people with disabilities in finding a safe place.
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Evacuate as instructed by the designated responsible official or the emergency coordinator.
FLOOD
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Where?
- Indoors
- Outdoors
INDOORS
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Be ready to evacuate as directed by the designated responsible official or the emergency coordinator.
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Follow the recommended primary or secondary evacuation routes.
OUTDOORS
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Climb to high ground and stay there.
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Avoid walking or driving through flood water.
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If car stalls, abandon it immediately and climb to a higher ground.
- Pass
- Fail
- N/A
HURRICANE
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When?
- A hurricane watch has been issued
- A hurricane warning has been issued
- During a hurricane
Once a hurricane watch has been issued
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Stay calm and await instructions from the designated responsible official or the emergency coordinator.
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Moor any boats securely, or move to a safe place if time allows.
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Continue to monitor local TV and radio stations for instructions.
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Move early out of low-lying areas or from the coast, at the request of officials.
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Collect drinking water in appropriate containers.
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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
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Be ready to evacuate as directed by the designated responsible official or the emergency coordinator.
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Leave areas that might be affected by storm tide or stream flooding.
During a hurricane
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Remain indoors.
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Consider small interior rooms on the lowest floor and without windows.
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Consider hallways on the lowest floor away from doors and windows.
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Consider rooms constructed with reinforced concrete, brick, or block with no windows.
BLIZZARD
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Where?
- Indoors
- Outdoors
- Stranded in a car or truck
INDOORS
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Stay calm and await instructions from the designated responsible official or the emergency coordinator.
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Stay indoors.
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Is there no heat?
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Close off unneeded rooms or areas.
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Stuff towels or rags in cracks under doors.
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Cover windows at night.
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Eat and drink.
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Food provides the body with energy and heat. Fluids prevent dehydration.
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Wear layers of loose-fitting, light-weight, warm clothing, if available.
OUTDOORS
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Find a dry shelter.
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Cover all exposed parts of the body.
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If shelter is not available, prepare a lean-to, windbreak, or snow cave for protection from the wind.
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Build a fire for heat and to attract attention.
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Place rocks around the fire to absorb and reflect heat.
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Do not eat snow because it will lower your body temperature. Melt it first.
STRANDED IN A CAR OR TRUCK
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Stay in the vehicle.
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Run the motor about ten minutes each hour.
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Open the windows a little for fresh air to avoid carbon monoxide poisoning.
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Make sure the exhaust pipe is not blocked.
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Make yourself visible to rescuers.
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Turn on the dome light at night when running the engine.
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Tie a colored cloth to your antenna or door.
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Raise the hood after the snow stops falling.
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Exercise to keep blood circulating and to keep warm.
BOMB THREAT
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Be calm.
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Be courteous.
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Listen.
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Caller's Identity Sex
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Approximate Age
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Origin of Call
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Voice Characteristics
- Loud
- High Pitch
- Raspy
- Intoxicated
- Soft
- Deep
- Pleasant
- Other
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Specify
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Speech
- Fast
- Distinct
- Stutter
- Slurred
- Slow
- Distorted
- Nasal
- Other
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Specify
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Language
- Excellent
- Fair
- Foul
- Good
- Poor
- Other
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Specify
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Accent
- Local
- Foreign
- Race
- Not Local
- Region
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Manner
- Calm
- Rational
- Coherent
- Deliberate
- Righteous
- Angry
- Irrational
- Incoherent
- Emotional
- Laughing
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Background Noises
- Factory
- Machines
- Music
- Office
- Machines
- Street
- Traffic
- Trains
- Animals
- Quiet
- Voices
- Airplanes
- Party
- Atmosphere
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Do not interrupt the caller.
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Pretend difficulty in hearing the caller so he/she keeps talking.
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Is the caller agreeable to further conversation?
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Certain hour the bomb will go off
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Time remaining until the bomb will go off
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Which building is the bomb located?
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Which area of the building is the bomb located?
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What kind of bomb is it?
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What kind of package is the bomb in?
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How does the caller know so much about the bomb?
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What is the caller's name and address?
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If the building is occupied, inform the caller that detonation could cause injury or death.
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Activate malicious call trace.
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Hang up phone and do not answer another line.
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Choose the same line and dial *57 (if your phone system has this capability).
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Listen for the confirmation announcement and hang up.
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Call security and relay information about the call.
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Security Contact Number
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Did the caller appear familiar with the plant or building (by his/her description of the bomb location)?
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The message in its entirety and any other comments
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Notify the designated responsible official or emergency coordinator immediately.
CHEMICAL SPILL
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Spill Containment and Security Equipment Location
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Personal Protective Equipment (PPE) Location
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Material Safety Data Sheet (MSDS) Location
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Spill Type
When a Large Chemical Spill has occurred
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Immediately notify the designated responsible official and the emergency coordinator.
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Contain the spill with available equipment (e.g., pads, booms, absorbent powder, etc.)
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Secure the area and alert other site personnel.
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Do not attempt to clean the spill unless trained to do so.
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Attend to injured personnel and call the medical emergency number, if required.
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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.
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Name of Spill Cleanup Company
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Contact Number
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Evacuate building as necessary
When a Small Chemical Spill has occurred
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Notify the designated responsible official or the emergency coordinator.
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If toxic fumes are present, secure the area (with caution tapes or cones) to prevent other personnel from entering.
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Deal with the spill in accordance with the instructions described in the MSDS.
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Small spills must be handled in a safe manner, while wearing the proper PPE.
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Review the general spill cleanup procedures.
STRUCTURE CLIMBING/DESCENDING EMERGENCIES
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Structure maintained by site personnel
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Structure Type
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Location (address, if applicable)
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Emergency Response Organization (if available within 30-minute response time)
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Emergency Response Organization Contact Number
EXTENDED POWER LOSS
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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.
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Facilities with freezing temperatures should turn off and drain the fire sprinkler system in the event of a long term power loss.
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Turn off and drain the standpipes in the event of a long term power loss.
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Turn off and drain the potable water lines in the event of a long term power loss.
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Turn off and drain the toilets in the even of a long term power loss.
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Add propylene-glycol to drains to prevent traps from freezing.
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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.
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Upon restoration of heat and power, electronic equipment should be brought up to ambient temperatures before energizing to prevent condensate from forming on circuitry.
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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.
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Is there personnel necessary to remain at their work areas to perform critical operations?
CRITICAL OPERATIONS
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Specially Assigned Personnel
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Work Area
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Name
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Job Title
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Description of Assignment
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Remain on the site upon the permission of the site designated responsible official or emergency coordinator.
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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.
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Office Name/Location
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Contact Number
TRAINING
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Personnel have been trained to ensure a safe and orderly emergency evacuation of other employees.
Trained Personnel
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Name
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Title
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Responsibility
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Training Date
EMERGENCY PHONE NUMBERS
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Fire Department
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Paramedics
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Ambulance
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Police
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Federal Protective Service
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Security (if applicable)
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Building Manager (if applicable)
UTILITY COMPANY EMERGENCY CONTACTS
Electric
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Name of the Company
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Phone Number
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Point of Contact
Water
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Name of the Company
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Phone Number
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Point of Contact
Telephone
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Name of the Company
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Phone Number
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Point of Contact
SIGN OFF
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Additional Observations
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Designated Responsible Official Name & Signature
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Emergency Coordinator Name & Signature
