Personal Emergency Evacuation Plan

• Name of Person

• Conducted on

  Date

• Prepared by

1. Personal Emergency Evacuation Plan

• Personal Disability

• Course attending?

• Buildings being used?

  Select Main Campus Sports Hall Classroom block Brickwork shop

  • Main Campus
  • Sports Hall
  • Classroom block
  • Brickwork shop

• Location and floor levels in respective buildings being used.

• Timetable

  Select Monday Tuesday Wednesday Thursday Friday Saturday Sunday

  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday

• Start and Finish times

• Catering facilities are located in the Refectory and Coffee Lounge areas within the Main Campus.

• Location of toilets

• Means of escape

• Do you have a personnel assistant?

  Yes

  No

  N/A

• Can you hear the audible alarm?<br>

  Yes

  No

  N/A

• Can you use stairs safely in an emergency?

  Yes

  No

  N/A

• Would you use the stairs without assistance?

  Yes

  No

  N/A

• Can you follow exit signs without assistance?

  Yes

  No

  N/A

• Do you use a wheelchair to aid mobility?

  Yes

  No

  N/A

• Is the wheelchair

  Electric

  Manual

• Will you use the wheelchair at all times when in the college?

  Yes

  No

  N/A

• Do you use any other type of mobility device?

  Yes

  No

  N/A

• Identify

• Do you need a 'buddy' to help with evacuation?

  Yes

  No

  N/A

• Identify who the 'buddy / s' are.

• Any further recommendations or comments?

  Yes

  No

  N/A

• Date completed

  Date

• Revision date

  Date

• Person being assessed

  Sign

• Tutor / Mentor / Responsible Person

  Sign

• Please detail