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RMS.08.15.348
Emergency Action Plan
Provided by:
Key Risk P.O. Box 49129
Greensboro, North Carolina 27419
800.942.0225
________________________________________________________________________________________
1 This document provides general information and suggestions related to workplace safety programs. It is not intended and cannot be assumed that every legally required and/or acceptable safety procedure is included herein or that it addresses issues applicable to your particular workplace
conditions or circumstances, and it cannot replace or substitute for the services of trained professionals. Although the information contained herein
was obtained from sources believed to be reliable, Key Risk Management Services, LLC and/or your W. R. Berkley insurance carrier make no guaranty and assume no liability or responsibility for the correctness, sufficiency, or completeness of such information and any errors or omissions in
the content of this publication or any damages incurred resulting from the use of the information contained herein
Emergency Preparedness – Written Program
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Emergency Action Plan
Table of Contents
ABOUT THIS GUIDE. ........................................................................................................ 2 PURPOSE .................................................................................................................... 3 DEFINITIONS ............................................................................................................... 3 RESPONSIBILITIES ........................................................................................................ 3
The Program Administrator: .............................................................................................................. 3 The Emergency Coordinator: ............................................................................................................. 3 Evacuation Leaders ............................................................................................................................ 4 Emergency Medical Team ................................................................................................................. 4 Managers and Supervisors ................................................................................................................. 4 Employees .......................................................................................................................................... 4
PROGRAM ACTIVITIES .................................................................................................. 4 Assessment ......................................................................................................................................... 4 Equipment .......................................................................................................................................... 5 Emergency Drills ............................................................................................................................... 5 Shelter Areas ...................................................................................................................................... 5 Evacuation.......................................................................................................................................... 5 Alarm Systems ................................................................................................................................... 5 Fire Protection System ....................................................................................................................... 6 Fire Prevention ................................................................................................................................... 6 Training .............................................................................................................................................. 6
FORMS ....................................................................................................................... 7 A – Emergency Assessment Form ..................................................................................................... 8
B – Emergency Call List .................................................................................................................... 9
C – Emergency Drill Evaluation Report .......................................................................................... 10
D – Emergency Equipment List ....................................................................................................... 11
E – Emergency Preparedness Training Record ................................................................................ 12
F – Emergency Response Information ............................................................................................. 13
G – Evacuation Assignment List ..................................................................................................... 15
H – Fire Inspection Checklist........................................................................................................... 16
I – Preferred Medical Provider List ................................................................................................. 21
J – Sample Earthquake Response Procedure ................................................................................... 22
K – Sample Evacuation Leader Procedure ...................................................................................... 23
L –Evacuation Route and Exit Map ................................................................................................. 24
M – Sample Head-Count Procedure ................................................................................................ 25
N – Sample Medical Emergency Procedure .................................................................................... 26
O – Sample Tornado Response Procedure ....................................................................................... 27
Emergency Preparedness – Written Program
RMS.08.15.348
Emergency Action Plan
About This Program
The following sample written program can help you develop an emergency action plan for your organization.
It is designed to walk you through the complete process section by section.
Here’s a closer look at each section:
Purpose: This section describes the purpose of the written program, what the program is expected to
accomplish and the employees, departments, operations and facilities that the program applies to. This may
include both nonemployees and contractors.
Definitions: This section defines terms found in the written program.
Responsibilities: This section identifies who is responsible for specific tasks within the program to assure its
success. Every program will have a variety of tasks or action items assigned to people in your organization.
When the expectations of the program are clearly written, each individual’s accountability within the
program can be clearly established.
Program Activities: This section describes the specific management directives (practices) that establish
organization, responsibility, authority and standards and identifies which are necessary to implement the
specific safety program. Practices must be specific and factual, not procedural. Practices provide guidance on
how a particular matter should be handled.
Forms: This section includes forms and other attachments that document important program information.
If you fill in the blanks with names and titles in the sample written program and complete the appropriate
forms that are provided, you will have created a written emergency action plan for your organization.
Note: Read and verify that the information in this sample written program accurately represents your
safety program. Attach all forms to your written program.
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Purpose
The purpose of this program is to establish emergency procedures and plans at Company Name.
This program applies to all company facilities that have the potential for emergency situations,
including building evacuations, severe weather, medical emergencies and earthquakes.
Definitions
Emergency:
Any unplanned event that can cause death or injury to employees, customers or the public or that
can shut down our business, disrupt operations or cause physical or environmental damage.
Evacuation Route:
The shortest path from an affected area to an area of safety, a shelter area or a location out of the
building.
Responsibilities
The Program Administrator: Name & Title
This person is responsible for:
Issuing and administering this program and making sure that it satisfies all applicable
federal, state and local requirements
Maintaining all emergency call lists
Maintaining the evacuation leader system
Providing initial and periodic training on emergency preparedness to employees
Scheduling and coordinating all emergency drills
Auditing the emergency action plan to assure its continued effectiveness
The Emergency Coordinator: Name & Title
This person is responsible for:
Coordinating emergency responses at this facility
Interfacing between outside emergency responders and building personnel
Verifying that all employees have left the building during emergencies that require building
evacuation
Assessing the need for outside emergency responders
Coordinating disaster response with outside emergency responders
Initiating the company’s post-emergency actions
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Evacuation Leaders: Names & Titles
These people are responsible for:
Knowing and understanding the appropriate emergency response at the facility
Understanding specific actions to be taken in their departments in response to various
emergencies, including equipment shutdowns
Assuring that employees in their departments know what to do in cases of emergencies
Accounting for employees during evacuations or shelter situations
Directing employees to proper evacuation routes and exits
Emergency Medical Team: Names & Titles
These people are responsible for:
Responding to medical emergencies in the facility and providing initial emergency first aid
or cardiopulmonary resuscitation (CPR)
Assessing the need for outside emergency responders
Contacting outside emergency responders and directing them to the accident scene in the
facility
Complying with the company’s blood borne pathogens program
Managers and Supervisors
These people are responsible for:
Assuring that employees in their departments are trained on the correct actions to take in the
event of an emergency
Accounting for their employees during an evacuation (head-count method)
Initiating employee accident investigation reports for employees who sustain injuries or
illnesses while on the job
Employees
These people are responsible for:
Knowing what to do in case of an emergency
Participating in all emergency training and drills
Program Activities
Assessment
Each company facility will be analyzed for the potential of emergency situations at that
facility
A copy of all assessments and practices will be issued to all key company employees
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This assessment will be reviewed annually to determine if situations have developed that
require new or revised emergency responses
At our facility, we have the potential for the following emergencies:
– Enter emergencies here
Equipment
Equipment kept for emergencies will be inspected on a monthly basis to assure its
availability for use
An emergency weather radio will be located at: Location
This radio will be monitored for emergency weather information by: Name & Title
Equipment for emergencies is listed on the emergency equipment list
Locations for emergency equipment will be identified on the facility emergency response
map
Emergency Drills
Drills that simulate evacuation of employees, due to fire or movement of employees to
shelter areas due to severe storms or tornadoes, will be conducted in each facility according
to the following timetable:
– A tornado drill will be performed once each year prior to the start of the tornado season
for the part of the country in which the facility is located. This drill should coincide with
that conducted by the local government emergency preparedness agency, should it
conduct a tornado drill
– Fire drills will be performed a minimum of once each year in each facility
Written documentation of the performance of each drill will be sent to the program
administrator
Shelter Areas
Shelter areas suitable for refuge during severe weather will be established at all company
facilities
The shelter location for this building is: Location
Evacuation
Exits and evacuation routes will be established for each building location
Locations of exits and evacuation routes will be maintained on the Facility Emergency
Preparedness Map
Alarm Systems
Notification of building emergencies will be communicated via the following methods:
– Enter Here
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The building fire alarm will be activated during the following situations:
– Enter Here
The building fire alarm sounds like:
– Enter Here
Other building alarms for Location(s) sound like: Enter Here
Announcements for medical emergencies will be made via the public address system
Fire Protection System
The building sprinkler system will be maintained according to the recommendations of the
property insurance carrier
The building sprinkler system will be inspected and tested annually
The building alarm system will be inspected annually according to insurance company
recommendations
Fire Prevention
Supervisors and managers will identify fire hazards within their departments and take
appropriate preventive actions
All employees are responsible for reporting fire hazards to supervisors or the maintenance
department immediately
Each department will have a monthly fire hazard inspection as part of its monthly safety
audit
Training
All employees will be oriented to the appropriate emergency response at time of hire
All employees will participate in periodic refresher training as part of safety meetings
Emergency coordinators and evacuation leaders will be trained annually on appropriate
responses within the workplace
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Forms
A – Emergency Assessment Form
B – Emergency Call List
C – Emergency Drill Evaluation Report
D – Emergency Equipment List
E – Emergency Preparedness Training Record
F – Emergency Response Information
G – Evacuation Assignment List
H – Fire Inspection Checklist
I – Preferred Medical Provider List
J – Sample Earthquake Response Procedure
K – Sample Evacuation Leader Procedure
L – Evacuation Route and Exit Map
M – Sample Head-Count Procedure
N – Sample Medical Emergency Response Procedure
O – Sample Tornado Response Procedure
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A – Emergency Assessment Form Instructions: This form is used to assess an emergency that may occur at your company. Use this form to
determine the potential problems that the emergency may pose, the type of equipment needed to respond to
the emergency, critical information needed at the time of the emergency and any special skills or knowledge
needed to effectively respond to the emergency.
Potential Emergency
Potential Problems Caused by the Emergency
Equipment Needed to Respond to the Emergency
Resources to Contact in the Event of an Emergency
Company Contact Phone Number
Skills Needed to Respond to the Emergency
Knowledge Needed to Respond to the Emergency
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B – Emergency Call List
Designated Company Emergency Responders
Name Work # Home # Pager # Cell #
1
2
3
4
5
6
7
Key Company Employees
Name Work # Home # Pager # Cell #
1
2
3
4
5
6
7
Other Resources
Resource Contact Phone
Local fire marshal office
Sprinkler contractor
Alarm monitoring
Power company
Gas company
Phone company
Salvage company
Restoration company
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C – Emergency Drill Evaluation Report
Type of Drill
Date of Drill
Time Drill Started
Time Drill Concluded
If the drill was to simulate an evacuation, how long did the evacuation take?
Time alarm sounded
Time all employees cleared the building and were accounted for
Total evacuation time
If the drill was for a non-evacuation emergency, describe the purpose of the drill:
Give a narrative to assess the drill, including what went well and what needs improvement:
Completed By
Date
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D – Emergency Equipment List
Instructions: This form is intended to document what equipment is available to use for emergency situations.
This information records the type, amount and location of emergency equipment. The form can also be used
to inspect the equipment to determine if all the equipment is available, the equipment is in serviceable
condition and no expiration dates have passed on perishable items such as food, medications, or batteries.
Equipment Type Stored Location Person Responsible
Inspection Information
Quantities
OK?
Condition
OK?
Expiration
Dates OK?
Yes No Yes No Yes No
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E – Emergency Preparedness Training Record
Facility
Department
Date
Employee Name &
Employee Identification
Number
Please print
Job Title
Please print
Employee
Signature
Name:
ID:
Name:
ID:
Name:
ID:
Name:
ID:
Name:
ID:
Name:
ID:
Name:
ID:
Name:
ID:
Name:
ID:
Name:
ID:
Name:
ID:
Name:
ID:
Signature of Trainer
F – Emergency Response Information
Assess the emergency, and determine the appropriate response.
Fire Emergency or Building Evacuation
1. Sound the local alarm (i.e., activate fire alarm via pull station, contact security, notify
supervisor, call switchboard).
2. Shut down equipment, as necessary.
3. Leave the building via designated evacuation routes. Use stairways. Do not use elevators.
4. Assemble at the designated meeting point.
5. Account for people in the building.
6. Remain outside the building until told that it is safe to reenter.
Medical Emergency
1. Shout for help to alert nearby employees.
2. Assess the medical emergency. Determine the type of injury or illness.
3. Contact emergency responders and key company employees in order of appearance on the call
list.
4. Appoint an employee to guide outside emergency responders to the site.
5. Assist emergency responders, as needed.
6. Complete a company accident investigation report and workers’ compensation reports for
injured employees.
Severe Weather
1. Stay away from windows or outside doors.
2. Shut down equipment, as necessary.
3. Seek shelter inside the building in designated shelter areas. Stay away from building areas with
large roof spans, such as cafeterias or auditoriums.
4. Account for people in building shelter areas.
5. Stay in shelter areas until the “all clear” signal is given.
6. Be aware of potential hazards from downed electrical lines and structural damage.
Earthquake
1. Keep calm. Stay indoors.
2. Take cover under a sturdy piece of furniture or counter, or brace yourself against an inside wall
or heavy framed doorway.
3. Protect your head and neck. Stay away from glass, windows, outside doors or loose items that
could fall.
4. After the earthquake, stay away from windows, skylights and items that could fall. If evacuation
is necessary, use stairways to leave the building. Do not use elevators.
5. Be aware of potential hazards from broken gas lines, downed electrical lines and structural
damage.
6. Account for people in the building.
Chemical Spill
1. Confine the hazard. Close doors and restrict access to the area. Do not attempt to clean up the
spill unless trained to do so. If spilled material is a flammable liquid, shut down or eliminate
sources of ignition.
2. Evacuate nonessential personnel from the area. Assist any injured personnel. Keep bystanders
from entering the spill area.
3. Report the spill to your supervisor or to the building emergency coordinator.
4. Do not reenter the building unless told to do so by the emergency coordinator or local fire
department.
G – Evacuation Assignment List
Emergency Coordinator
Assistant Emergency Coordinator
Department/Building Area Leader #1 Leader #2
Identify the location where all leaders will check in after their departments have been evacuated:
H – Fire Inspection Checklist Initials
Taken from the OSHA Handbook for Small Businesses, U.S. Department of Labor
Date
This checklist is by no means all inclusive. Add or delete portions or items that do not apply to your
operations.
GENERAL WORK ENVIRONMENT Yes No NA COMMENTS
1. Is your local fire department well acquainted with your
facilities, its location and specific hazards?
2. If you have a fire alarm system, is it certified as required?
3. If you have a fire alarm system, is it tested at least annually?
4. Are fire doors and shutters in good operating condition?
5. Are fire doors and shutters unobstructed and protected against
obstructions, including their counterweights?
6. Are fire door and shutter fusible links in place?
7. Are sprinkler heads protected by metal guards when exposed
to physical damage?
8. Is an 18” clearance maintained below sprinkler heads?
9. Are fire extinguishers mounted in readily accessible locations?
10. Are fire extinguishers recharged regularly and noted as such
on the inspection tags?
11. Are fire extinguishers checked monthly when flammables or
chemicals are present?
12. Are fire extinguisher locations identified by signage?
13. Are all work sites clean and orderly?
14. Is combustible scrap, debris and waste stored safely and
removed from the work site promptly?
15. Are accumulations of combustible dust routinely removed
from elevated surfaces including the overhead structures of
buildings, etc.?
16. Is combustible dust cleaned up with a vacuum system to
prevent the dust going into suspension?
17. Are covered metal waste cans used for oily and paint-soaked
waste?
18. Are paint spray booths, dip tanks, etc. cleaned regularly?
19. Are fire watchers assigned when welding or cutting is
performed in locations where a serious fire might develop?
20. Before hot work is begun, are used drums, barrels, tanks and
other containers so thoroughly cleaned that no substances
remain that could explode, ignite or produce toxic vapors?
WALKWAYS Yes No NA COMMENTS
1. Are aisles and passageways kept clear?
2. Are changes of direction or elevation readily identifiable?
EXITS OR EGRESS Yes No NA COMMENTS
1. Are all exits marked with exit signs and illuminated by
reliable light sources?
2. Are the directions to exits, when not immediately apparent,
marked with visible signs?
3. Are doors, passageways or stairways, that are neither exits nor
access to exits and which could be mistaken for exits,
appropriately marked “NOT AN EXIT,” “TO BASEMENT,”
“STOREROOM,” etc.?
4. Are exit signs provided with the word “EXIT” in lettering at
least 5 inches high and the stroke of the lettering at least ½
inch wide?
5. Are all exit doors side hinged?
6. Are all exits kept free of obstructions?
7. Are at least two means of egress provided from elevated
platforms, pits or rooms where the absence of a second exit
would increase the risk of injury from hot, poisonous,
corrosive, suffocating, flammable or explosive substances?
8. Are there sufficient exits to permit prompt escape in case of
emergency?
9. Do all exit doors open outward to level surfaces or stairs?
10. Are emergency lights provided and inspected?
11. Will all exits operate during a power failure?
12. Are all exits checked regularly for blockage from outside?
EXIT DOORS Yes No NA COMMENTS
1. Are all doors which are required to serve as exits designed and
constructed so that the way of exit travel is obvious and
direct?
2. Are all exit doors openable from the direction of exit travel
without the use of a key or any special knowledge or effort
when the building is occupied?
3. Are all revolving, sliding or overhead doors prohibited from
serving as required exit doors?
4. Where panic hardware is installed on required exit doors, will
it allow the doors to open by applying a force of 15 pounds or
less in the direction of the exit traffic?
EXIT DOORS Yes No NA COMMENTS
5. Are all doors on cold storage rooms provided with an inside
release mechanism which will release the latch and open the
door even if it is padlocked or otherwise locked on the
outside?
6. Where exit doors open directly onto any street, alley or other
area where vehicles may be operated, are adequate barriers
and warnings provided to prevent employees from stepping
into the path of traffic?
SPRAYING OPERATIONS Yes No NA COMMENTS
1. Is adequate ventilation assured before spray operations are
started?
2. Is mechanical ventilation provided when spraying operations
are done in enclosed areas?
3. Is the spray area free of hot surfaces?
4. Is the spray area at least 20 feet from flames, sparks, operating
electrical motors and other ignition sources?
5. Do solvents used for cleaning have a flash point of 100F or
more?
6. Are fire control sprinkler heads kept clean?
7. Are “NO SMOKING” signs posted in spray areas, paint
rooms, paint booths and paint storage areas?
8. Is the spray area kept clean of combustible residue?
9. Are spray booths constructed of metal, masonry or other
substantial noncombustible material?
10. Are spray booth floors and baffles noncombustible and easily
cleaned?
11. Is the spray booth completely ventilated before using the
drying apparatus?
12. Are lighting fixtures for spray booths located outside the
booths and the interiors lighted through sealed clear panels?
13. Are the electric motors for exhaust fans placed outside booths
or ducts?
14. Are belts and pulleys inside the booths fully enclosed?
15. Do ducts have access doors to allow cleaning?
16. Do all drying spaces have adequate ventilation?
FLAMMABLE AND COMBUSTIBLE MATERIALS Yes No NA COMMENTS
1. Are combustible scrap, debris and waste materials (oily rags,
etc.) stored in covered metal receptacles and removed from the
work site promptly?
FLAMMABLE AND COMBUSTIBLE MATERIALS Yes No NA COMMENTS
2. Are approved and labeled containers and safety cans and tanks
used for storage and handling of flammable and combustible
liquids?
3. Are all connections tight on drums and combustible liquid
piping, vapor and liquid?
4. Are all flammable liquids kept in closed containers when not
in use (e.g., parts cleaning tanks, pans, etc.)?
5. Are bulk drums of flammable liquids grounded and bonded to
containers during dispensing?
6. Do storage rooms for flammable and combustible liquids have
explosion-proof lights?
7. Do storage rooms for flammable and combustible liquids have
mechanical or gravity ventilation?
8. Is liquefied petroleum gas stored, handled and used in
accordance with safe practices and standards?
9. Are NO SMOKING signs posted on liquefied petroleum gas
tanks?
10. Are liquefied petroleum storage tanks guarded to prevent
damage from vehicles?
11. Are all solvent wastes and flammable liquids kept in fire-
resistant, covered containers until they are removed from the
work site?
12. Are fuel gas cylinders and oxygen cylinders separated by a 20-
foot distance or by fire-resistant barriers while in storage?
13. Are appropriate fire extinguishers mounted within 75 feet of
outside areas containing flammable liquids and within 10 feet
of any inside storage areas for such materials?
14. Are extinguishers free from obstructions or blockage?
15. Are NO SMOKING signs posted where appropriate in areas
where flammable or combustible materials are used or stored?
16. Are all spills of flammable or combustible liquids cleaned up
promptly?
17. Are NO SMOKING rules enforced in areas involving storage
and use of hazardous materials?
ELECTRICAL Yes No NA COMMENTS
1. Are multiple-plug adapters prohibited?
2. Are extension cords prohibited from being run through doors
and windows?
3. If there are electrical installations in hazardous dust or vapor
areas, do they meet the National Electrical Code (NEC) for
hazardous locations?
ELECTRICAL Yes No NA COMMENTS
4. Are exposed wiring and cords with frayed or deteriorated
insulation repaired or replaced promptly?
5. Are flexible cords and cables free of splicing or taps?
FUELING Yes No NA COMMENTS
1. Is it prohibited to fuel an internal combustion engine with a
flammable liquid while the engine is running?
2. Are fueling operations done in such a manner that likelihood
of spillage will be minimal?
3. When spillage occurs during fueling operations, is the spilled
fuel washed away completely, evaporated or other measures
taken to control vapors before restarting the engine?
4. In fueling operations, is there always metal contact between
the container and the fuel tank?
5. Are fueling hoses of a type designed to handle the specific
types of fuel?
6. Is it prohibited to handle or transfer gasoline in open
containers?
7. Are smoking, open lights, open flames and sparking or arcing
equipment prohibited near fueling or transfer of fuel
operations?
8. Are fueling operations prohibited in building or other enclosed
areas that are not specifically ventilated for this purpose?
9. Where fueling or transfer of fuel is done through a gravity
flow system, are the nozzles of the self-closing type?
10. Are TURN OFF ENGINE and NO SMOKING signs posted at
fuel islands?
11. Is a fire extinguisher available in case of emergency?
12. Are fuel tanks properly labeled NO SMOKING?
13. Are above-ground tanks protected from spills by a dike?
OTHER Yes No NA COMMENTS
1.
2.
3.
4.
5.
6.
I – Preferred Medical Provider List
Company
Address
The following are the preferred treatment locations for employee injuries:
Preferred Treatment Location
Hospital/Clinic Name
Address
City
State
Zip
Phone
Hours of Service
Alternate Treatment Location
Hospital/Clinic Name
Address
City
State
Zip
Phone
Hours of Service
Preferred Trauma Center
Hospital/Clinic Name
Address
City
State
Zip
Phone
Hours of Service
J – Sample Earthquake Response Procedure
1. Keep calm. Assess the situation around you. Look out for items that could fall or topple over on
you.
2. Stay indoors. Most injuries occur when people rush out of the building and are hit by falling
debris.
3. Take cover under a sturdy piece of furniture or counter. Choose a shelter that will provide an air
space if the building collapses. If your shelter moves, follow it and stay under it.
4. If there is no item under which you can take cover, stand in a doorway or brace yourself against
an inside wall.
5. Protect your head and neck. Stay away from glass, windows, outside doors or loose items that
could fall.
6. If you are outside, stay there. Move away from buildings, walls, utility poles and overhead wires.
If you are in a moving car, stop as quickly and safely as possible. Do not stop near bridges or
overpasses or where buildings could topple over onto your vehicle.
7. After the shaking stops, take time to assess the quake effects. Be prepared for possible after-
shocks. If evacuation is necessary, use stairways to leave the building. Do not use elevators. Be
aware of structural damage and loose items in cabinets and closets. Carefully open doors to
storage areas.
8. Be aware of gas leaks. Do not operate electrical equipment, smoke or use open flames. If you
smell gas, leave the building and shut off the gas supply at the main shut-off point.
9. Make a quick initial check for people who may be injured or trapped. Provide emergency first
aid if needed. Do not try to move seriously injured persons unless they are in immediate danger
of further injury. Account for all people in the building.
10. Key company employees will meet at:
to determine the impact of the earthquake upon company operations. A decision will be made
on steps to be taken to resume company operations based on discussions with the fire
department or local emergency management representatives. Steps to consider include
retaining employees at work, cleanup and salvage, protection of building contents and
resumption of normal company operations.
K – Sample Evacuation Leader Procedure
Instructions: Follow this procedure when the building must be evacuated due to fire, chemical release or
other conditions that require employees to leave the building. This procedure uses the evacuation leader
method of accounting for employees.
1. Fire alarms in the building will be activated by the following methods:
Automatically via smoke detectors, heat detectors or sprinkler flow
Manually via wall-mounted pull stations
2. If there is no fire alarm system in the building, supervisors and evacuation leaders will spread
the alarm throughout the building to all employees. If the fire alarm system does not
automatically contact the fire department, the receptionist or other key person will call the fire
department by dialing 911 or
3. After a fire or evacuation alarm has been sounded, the evacuation leaders will assist in the
orderly evacuation of all employees from their areas of responsibility. Leaders will initiate
searches of their designated areas, including rest rooms or other closed rooms to assure that all
employees, contractors and visitors have left the building.
4. If, during searches of their areas, the evacuation leaders find the source of the fire, they will
limit the fire by closing doors to the areas or, if appropriate, by attempting to extinguish the fire
with available fire extinguishers.
5. Evacuation leaders will proceed to the evacuation team meeting place, located at
Once there, leaders will check in with the emergency coordinator and advise him or her of the
evacuation statuses of their areas.
6. If the fire was in a given evacuation leader’s area, he or she will inform the emergency
coordinator of the location and extent of the fire or source of the alarm.
7. The emergency coordinator will advise the arriving fire department of the status of the
evacuation and the source of the fire, if known.
8. Key company employees will meet at the evacuation team meeting place to determine the status
of the evacuation and the impact the evacuation has on company operations. A decision will be
made on steps to resume company operations, based on discussions with the fire department.
Steps to consider include retaining employees at work, cleanup and salvage, protection of
building contents and resumption of normal company operations.
L –Evacuation Route and Exit Map
Instructions: Photocopy a blueprint of the facility or use an online application, and draw lines to identify
evacuation routes and exits. When complete, make color photocopies of the master, and post them where
employees can refer to them.
Insert Photo
M – Sample Head-Count Procedure
Instructions: Follow this procedure when the building must be evacuated due to fire, chemical release or
other conditions that require employees to leave the building. This procedure uses the head count method to
account for employees.
1. Fire alarms in the building will be activated by the following methods:
Automatically via smoke detectors, heat detectors or sprinkler flow
Manually via wall-mounted pull stations
2. If there is no fire alarm system in the building, supervisors will verbally spread the alarm
throughout the building to all employees. If the fire alarm system does not automatically contact
the fire department, the receptionist or other key company employee will call the fire
department by dialing 911 or
3. After a fire or evacuation alarm has been sounded, all employees will leave the building via the
closest exit or designated evacuation route.
4. Employees will proceed to their designated meeting places. Meeting place assignments are as
follows:
Department Meeting Location
5. Once at their designated meeting places, employees will check in with their supervisors. Once
all employees have checked in or been accounted for, supervisors will then contact the
emergency coordinator and advise him or her of the evacuation status of their areas.
6. If the fire was in a given supervisor’s area, the supervisor will inform the emergency
coordinator of the location and extent of the fire or source of the alarm, if other than fire, such as
a false alarm or sprinkler damage.
7. The emergency coordinator will advise the arriving fire department of the status of the
evacuation and the source of the fire, if known.
8. Key company employees will meet at the evacuation team meeting place to determine the status
of the evacuation and the impact the evacuation has on company operations. A decision will be
made on steps to resume company operations, based on discussions with the fire department.
Steps to consider include retaining employees at work, cleanup and salvage, protection of
building contents and resumption of normal company operations.
N – Sample Medical Emergency Procedure
Instructions: Follow this procedure when an injury or sudden illness occurs that requires assistance from
designated company emergency responders trained in first aid or cardiopulmonary resuscitation (CPR). The
designated company emergency responders will assess the situation to determine the need for outside
emergency response.
1. If an employee becomes injured or suddenly ill, his or her co-workers or supervisor should
assess the injury or illness to determine if additional assistance is needed.
2. If the employee’s condition appears life threatening, an ambulance or local paramedics should
be called immediately. Someone attending the victim should be assigned to wait at the door to
which the paramedics were directed and guide them to the victim’s location.
3. If the victim’s condition requires additional medical assistance from designated company
emergency responders, they will be alerted by direct contact using the information on the
emergency call list or by paging via the building public address system.
4. If the paging must be done from the receptionist, he or she will be contacted, and the page
request will be given. The person requesting assistance should clearly state who he or she is and
where the designated company emergency responders are needed.
5. The receptionist will then make the page on the public address system using the following
words: “Medical emergency at _____________________________.” This message will be
repeated twice.
6. Those individuals who are designated to respond are to immediately go to the location indicated
in the page and provide whatever assistance is necessary. If outside emergency medical
assistance is needed, it shall be requested according to item 2 above.
7. All injuries other than minor first aid cases will be evaluated by the company’s preferred
medical provider.
8. All injured employees sent out for medical treatment will be accompanied by their supervisors
or other designated manager or supervisor.
9. The supervisor or manager of the injured employee will initiate an accident investigation and
complete a company employee injury report, as appropriate.
O – Sample Tornado Response Procedure
Instructions: Follow this procedure when weather conditions indicate that a tornado or other severe weather
may affect company facilities. This procedure assumes that designated personnel on the emergency call list
will be contacted to make the decision to have building employees take cover in designated shelter areas.
1. A weather alert radio will be kept at the receptionist’s desk. He or she will monitor emergency
weather broadcasts made by the National Weather Service (NWS). If the NWS broadcasts a
Tornado Watch, the receptionist will contact key company employees on the emergency call
list and advise them of the potential weather conditions.
2. If the NWS issues a Tornado Warning, the receptionist will immediately contact available key
company employees and advise them that a warning has been issued.
3. Key company employees will proceed to the receptionist’s desk and decide if the approaching
weather system affects the company facility. This decision will be based on NWS broadcasts,
commercial radio broadcasts and observation of approaching weather.
4. If the decision is made to send employees to shelter areas, an announcement will be made on the
company public address system. Employees will be accounted for in shelter areas.
5. All employees will go to shelter areas and remain there until the weather system has passed and
an “all clear” has been issued by the NWS.
6. When leaving shelter areas, employees must be aware of any building damage or downed power
lines outside the building.
7. Key company employees will evaluate the effects of the storm and decide whether to continue
building operations, as appropriate.