OSHA Emergency Action Plan Template

• Company

• Location
  Address

• Assessed by

• Conducted on

  Date

GENERAL ISSUES

• Does the plan consider all potential natural or man-made emergencies that could disrupt your workplace?

  Yes

  No

  Not sure

• Does the plan consider all potential internal sources of emergencies that could disrupt your workplace?

  Yes

  No

  Not sure

• Does the plan consider the impact of these internal and external emergencies on the workplace's operations and is the response tailored to the workplace?

  Yes

  No

  Not sure

• Does the plan contain a list of key personnel with contact information as well as contact information for local emergency responders, agencies and contractors?

  Yes

  No

  Not sure

• Does the plan contain the names, titles, departments, and telephone numbers of individuals to contact for additional information or an explanation of duties and responsibilities under the plan?

  Yes

  No

  Not sure

• Does the plan address how rescue operations will be performed?

  Yes

  No

  Not sure

• Does the plan address how medical assistance will be provided?

  Yes

  No

  Not sure

• Does the plan identify how or where personal information on employees can be obtained in an emergency?

  Yes

  No

  Not sure

EVACUATION POLICY AND PROCEDURES

• Does the plan identify the conditions under which an evacuation would be necessary?

  Yes

  No

  Not sure

• Does the plan identify a clear chain of command and designate a person authorized to order an evacuation or shutdown of operations?

  Yes

  No

  Not sure

• Does the plan address the types of actions expected of different employees for the various types of potential emergencies?

  Yes

  No

  Not sure

• Does the plan designate who, if anyone, will stay to shut down critical operations during an evacuation?

  Yes

  No

  Not sure

• Does the plan outline specific evacuation routes and exits and are these posted in the workplace where they are easily accessible to all employees?

  Yes

  No

  Not sure

• Does the plan address procedures for assisting people during evacuations, particularly those with disabilities or who do not speak English?

  Yes

  No

  Not sure

• Does the plan identify one or more assembly areas (as necessary for different types of emergencies) where employees will gather and a method for accounting for all employees?

  Yes

  No

  Not sure

• Does the plan address how visitors will be assisted in evacuation and accounted for?

  Yes

  No

  Not sure

REPORTING EMERGENCIES AND ALERTING EMPLOYEES IN AN EMERGENCY

• Does the plan identify a preferred method for reporting fires and other emergencies?

  Yes

  No

  Not sure

• Does the plan describe the method to be used to alert employees, including disabled workers, to evacuate or take other action?

  Yes

  No

  Not sure

EMPLOYEE TRAINING AND DRILLS

• Does the plan identify how and when employees will be trained so that they understand the types of emergencies that may occur, their responsibilities and actions as outlined in the plan?

  Yes

  No

  Not sure

• Does the plan address how and when retraining will be conducted?

  Yes

  No

  Not sure

• Does the plan address if and how often drills will be conducted?

  Yes

  No

  Not sure

COMPLETION

• Overall Recommendations

• Employer's Name & Signature

  Sign