Information

  • PEEP Record for:

  • Conducted on

  • Prepared by

  • Other Personnel involved

  • A Personal Emergency Evacuation Procedure ( known as a PEEP), is a procedure designed to outline the emergency requirements of a member of staff who may require assistance where theirs affects their method of egress in an emergency.

General

  • Where are you based for most of your time at work?

  • On which days are you expected in work?

  • Are you aware of the emergency procedures for the areas where you are based?<br>

  • Can you hear the fire alarm in the areas where you work or are based?

  • Can you move quickly in the event of an emergency?

  • Are you able to use stairs to enter/leave buildings without difficulty?

  • Could you raise the alarm if you discovered a fire?

  • Are you able to leave your work area without assistance in the event of an emergency?

  • If assistance is needed, do you have a nominated person to help you in an emergency?

  • Is this arrangement a formal one?

  • Are you always in easy contact with those who are designated to help you?

Hearing impairment

  • Can you hear the fire alarm under normal circumstances?

  • Do you have adequate devices to allow you to hear the alarm clearly? <br><br>If 'no', please make a note below of any special or purpose designed device that could assist you in hearing the alarm more clearly.

  • Are there sufficient measures in place that would assist you in leaving the building safely in the event of an emergency?<br><br>If 'no', please make a note below of what additional measures could help:<br>For example:<br>Would visual alarm indicators help?<br>Would written emergency procedures help?<br>Would an assistant/buddy system help?

  • Are you happy that all issues are covered above?<br>If 'no', please make a note of any additional concerns below

Visual impairment

  • Are you able to leave the area/building safely in the event of an emergency?

  • Are you able to move around the building without aids or assistance?<br>If 'no', please make a note of the equipment or support that you have access to - this could include use of a cane, guide dog, support worker etc

  • Under normal circumstances, how long does it take you to leave the area/building using your current support methods?

  • Are there sufficient measures in place to assist you in leaving the area/building in the event of an emergency?<br>If 'no', make a note below of any additional measures that may be of assistance. <br><br>These could include:<br>Emergency procedures in Braille, audible methods, large print, tactile floor surfaces, signage etc

  • Are you happy that all issues have been covered above? <br>If 'no', please make a note of any additional concerns below

Mobility impairment

  • Can you leave the building unassisted?<br>If 'no' what support is necessary to assist you?<br>This could include:<br>Use of a wheelchair, or use of a support person etc

  • If you use a wheelchair, are you able to leave the chair and move short distances if required?

  • Is your wheelchair a standard size and able to fit through standard size doors?

  • Have you ever been shown how an evac chair operates to assist you in leaving the area in an emergency?<br>If 'no', please make a note below to provide information about:<br>Would you be able to use a chair if required?<br>Would you like a familiarisation session to show you how they work?

  • Has the concept of 'fire refuge points' been explained to you?

  • If necessary, would you find it acceptable to use a fire refuge point?

  • Do you have access to a support person or buddy who would assist you and stay with you in an emergency?

  • Are there sufficient measures in place to assist you in leaving the area in the event of an emergency? If 'no', please make a note below of any additional measures that you feel would assist you.<br><br>These could include: relocation of work desk to a ground floor level, implementing buddy systems, provision of emergency procedures in a format suitable to the individual, per-planning emergency evacuation routes.

  • Are you happy that all issues have been covered above?<br>If 'no', please make a note below of any additional concerns that you may have.

Tour of the work area/building that you most commonly use.

  • Is the directional and instructional signage adequate and relevant?

  • (if you have a hearing impairment) - are there illuminated alarm devices within the toilet areas that you would use?

  • (if you have a partial mobility or visual impairment) - do you routinely negotiate stair wells and/or lifts?<br>

  • If you use stairs, are the edges of the treads of the stairs adequately identified?

  • If you use lifts, is there easy access/egress from the lift and is the lift easy to operate?

  • If you use a lift, is there an emergency telephone or other communication method installed in the lift?

  • There will be fire doors with self closing devices on your exit routes - are you able to negotiate these doors without too much hindrance?

  • If there are internal or external steps on your exit route, can you negotiate these without too much hindrance?

Declaration

  • If at this stage you have decided that you do not want a Personal Emergency Evacuation Plan please sign the statement below:

  • Staff Member

  • HS&S Specialist

  • Staff Member: Type name and sign

Summary of arrangements

  • PEEP - summary

  • This PEEP belongs to: (include the SESA number, contact details and Job role)

  • I will be informed of an evacuation by:

    Existing alarm
    Visual alarm system
    Buddy/support system
    Other..............

  • The following persons have been designated to provide assistance to help me exit the building in an emergency:

  • The following procedure will be followed: ( from the discovery of a fire - to the alarm activation - to leaving the work area - to arriving at the refuge point or assembly point)

  • Draw escape route if that helps

  • The following training/practice requirements have been identified:

  • A copy of my PEEP has been provided too: My Manager and Peoplelink

  • PEEP accepted by: Staff Member:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.