Emergency Response Plan Template

• Company name

• Location
  Address

• Prepared by

• Prepared on

  Date

• Potential emergency situations (based on the conducted hazard and risk assessment)

Emergency Equipment

• Equipment

• Location

• Operating Procedures

First Aid

• First aid kit and location

• First aid supplies and location

• Name/s of first aider/s in the morning, afternoon, and night shifts

• Transportation plan

Emergency Facilities

• Facility Name

• Contact Person and Number

• Address

• Alarm and emergency communication requirements

• Rescue and evacuation procedures

• Emergency response procedures

Emergency Response Training and Requirements

• List the names and job titles of employees trained to use each emergency equipment and perform emergency response procedures including rescue and evacuation.

• Employee Name and Title

• Shift (Morning, Afternoon, or Night)

• Training Received

• Training Frequency

Representatives and Teams Responsible for Creating the ERP

• Employee Name and Job Title

• Department/Team

• Property management company contact name and number

• Is there a written emergency response plan for each work site that aligns with the hazards at the site?

  Yes

  No

• Does this plan include a list of potential emergencies?

  Yes

  No

• Does this plan include emergency response procedures?

  Yes

  No

• Does this plan include a list of workers trained to provide emergency response procedures?

  Yes

  No

• Does this plan include rescue and evacuation procedures?

  Yes

  No

• Does this plan include a list of workers trained to provide rescue and evacuation procedures?

  Yes

  No

• Does this plan include emergency response training requirements?

  Yes

  No

• Does this plan include alarm and emergency communication requirements?

  Yes

  No

• Does this plan include a list and the locations of emergency equipment and facilities?

  Yes

  No

• Does this plan include emergency contact information?

  Yes

  No

• Do your first aid suppliers comply with legal requirements?

  Yes

  No

• Is the number of your first aid responders enough?

  Yes

  No

• Are workers informed of their responsibilities stated in the plan?

  Yes

  No

• Are emergency response drills conducted on a regular basis?

  Yes

  No

• Is the plan current and/or updated?

  Yes

  No

• Comments and recommendations

• Signature

  Sign