Information
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Site conducted
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Plan type
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Site name
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Location
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Accountable H&S representative
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Conducted on
CHANGE CONTROL
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Version
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Reason for change control
PLAN CHECKLIST
FIRE EVACUATION STRATEGY
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To raise the alarm and evacuate the building immediately.
METHOD OF FIRE DETECTION
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The following methods of detection are implemented in the premises:
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Automatic detection by smoke detectors linked to a fire alarm.
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Manual detection with activation of megaphone
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Other (please specify)
ACTION OF DISCOVERING FIRE
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Upon discovering a fire (what action should a non-H&S member take)
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Alert the H&S representative (fire marshal)
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Can the Fire Marshall fight the fire?
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Upon being informed or discovering a fire (what action should you take)
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Sound the megaphone.
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Other.
ACTION ON HEARING A FIRE
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Upon hearing an alarm the following action should be taken:
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Make your way to the emergency assembly point.
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Do not stop to collect belongings:?
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Once assembled start leaving the building.
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The H&S leaves last to ensure that everyone has evacuated. [ONLY IF IT IS SAFE]
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Description of emergency assembly point.
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Role of the facilitator and roll call.
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How will you deal with physically disabled person that cannot evacuate on their own?
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Who will conduct roll call once outside the building?
CALLING THE FIRE AND RESCUE SERVICES
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Who is accountable for calling the emergency services?
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Who is accountable for alerting security?
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What is the number to call?
IDENTIFICATION OF KEY ESCAPE ROUTES
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The main escape route is:
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A secondary escape route is:
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Sketch of esacape route and photos [please upload]
ACTIVE SHOOTER AND/ OR WORKPLACE VIOLENCE
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An Active Shooter is an individual actively engaged in killing or attempting to kill people in a confined and populated area, typically through the use of firearms.
EVACUATE IF SAFE TO DO SO
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Alert the H&S representative (if possible)
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Follow escape route if safe to do so
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Do not stop to collect belongings:?
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Role of the facilitator and roll call.
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How will you deal with physically disabled person that cannot evacuate on their own?
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Who will conduct roll call once outside the building?
HIDE FROM SHOOTER
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How should you and others hide from shooter?
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Is there specific places you can hide?
CALLING LAW ENFORCEMENT AND/OR SECURITY
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Who is accountable for calling?
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What is the number to call?
RESONDING TO LAW ENFORCEMENT
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Who is accountable for responding to law enforcement?
BOMB THREATS
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A bomb threat can be delivered or phoned in.
ALERTING THE RESPONSIBLE PERSON
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Whoever receives the bomb threat must alert the H&S representative immediately.
EVACUATE IF SAFE TO DO SO
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Follow escape route if safe to do so
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Do not stop to collect belongings:?
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Role of the facilitator and roll call.
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How will you deal with physically disabled person that cannot evacuate on their own?
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Who will conduct roll call once outside the building?
CALLING LAW ENFORCEMENT AND/OR SECURITY
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Who is accountable for calling?
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What is the number to call?
RESONDING TO LAW ENFORCEMENT
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Who is accountable for responding to law enforcement?
MEDICAL EMERGENCIES PROCEDURES
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Only trained responders (H&S representatives) should provide first aid assistance
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Do not move the injured person unless the location is unsafe
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Take “universal precautions” to prevent contact with body fluids and exposure to bloodborne pathogens
RESPONDING TO THE INJURED PERSON
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Provide assistance as necessary, i.e.:
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CPR
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Stop bleeding
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Assist with epilepsy attack
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Clear the air passages using the Heimlich Maneuver in case of chocking
CALLING AN AMBULANCE
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Who is accountable for calling?
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What is the number to call?
RESONDING TO MEDICAL PERSONNEL
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Who is accountable for responding to medical personnel?
DECLARATION & NEXT AUDIT
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I hereby declare that the information I state in the audit report is accurate, and that the audit was conducted to my best ability.
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Next scheduled audit
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Full name & ID number
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Signature
