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Emergency Action Plan

Sample Written Program

This sample program has been prepared to provide assistance in compliance with USA OSHA standards and/or Best Management Practices.  It should not be used without consideration of the unique conditions and requirements at each site.  It may be necessary to modify the program for your specific needs.  You remain under obligation to comply with all applicable standards, and use of this program should not be considered to be a guarantee that compliance with applicable requirements will be achieved.  It is strongly suggested that your final program be reviewed by a qualified person.   The best written program without implementation is inadequate.


Emergency Action Plan

COMPANY:

ADDRESS:

I. EMERGENCY PLAN COORDINATOR

NAME:
TITLE:
DEPARTMENT:
TELEPHONE NO:

II. PREFERRED MEANS OF REPORTING FIRES AND OTHER EMERGENCIES

Type Emergency Report By

Fire

Explosion

Tornado/Weather

Bomb Threat

Chemical Spill/Leak

Violence

Medical

Other

III. ELEMENTS

A. Emergency Escape Procedures and Routes

Emergency escape procedures and route assignments have been posted in each work area, and all employees have been trained by supervision in the correct procedures to follow. New employees are trained when assigned to a work area. A sample escape procedure and escape route sheet of the type posted in work areas is given in Appendix A.

B. Procedure for Employees Who Remain to Operate Critical Operations Before They Evacuate

The attached sheet (Appendix B) describes operations, procedures, and personnel required in order for critical operations to be performed before the assigned personnel evacuate during emergency situations. A description of the special training provided is also included.

C. Employee Accountability Procedures After Evacuations

Each supervisor is responsible for accounting for all assigned employees, personally or through a designee, by having all such employees report to a predetermined designated rally point and conducting a head count. Each assigned employee must be accounted for by name. All supervisors are required to report their head count (by name) to the Emergency Evacuation Coordinator. A summary of the evacuation rally points, together with the identities of supervisors and assigned employees who must report to each, is also given in Appendix A.

D. Rescue and Medical Duties

Specific rescue and medical duties have been assigned to designated individuals. These personnel have received special training and instructions for properly carrying out these assignments. A list of the individuals assigned and a summary of their training are attached (in Appendix C) for review.

E. Alarm System

Alarm systems for notifying all employees in case of an emergency are:

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

When so required by specific OSHA Standards, the organization will comply with OSHA Standard 1910.165, Employee Alarm Systems.

F. Training

The following personnel have been trained to assist in the safe and orderly emergency evacuation of other employees. See also Appendix B.

Name                    Title                   Work Area Special Assignment

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Training is provided for employees when:

1. The plan was initiated

2. Responsibilities change

3. New employees are hired or transferred

IV. EMERGENCY SHUTDOWN PROCEDURES

During some emergency situations, it will be necessary for some specifically assigned and properly trained employees to remain in work areas that are being evacuated long enough to perform critical operations. These assignments are necessary to ensure proper emergency control.

Assignments

Work Area          Name       Job Title       Description of Assignment

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

V. SPECIAL TRAINING

The preceding individuals have received special instructions and training by their immediate supervisors to ensure their safety in carrying out the designated assignments. A training record describing the instructions provided and the detailed procedures to be followed is maintained in the Emergency Plan and Fire Protection Plan Coordinator's Office.

Emergency and Fire Protection Plan Coordinator:

Name:                                                                            Date:

____________________________________________________

____________________________________________________

VI. EMPLOYEE ACCOUNTABILITY PROCEDURES FOLLOWING AN EMERGENCY EVACUATION

Each supervisor is responsible for accounting for each assigned employee following an emergency evacuation. This will be accomplished by performing the procedures established for such an eventuality.

VII. EMPLOYEE ACCOUNTABILITY

1. Rally points have been established for all evacuation routes and procedures. These points are designated on each posted work area escape route.

2. All work area supervisors and employees must report to their designated rally points immediately following an evacuation.

3. Each employee is responsible for reporting to his or her supervisor so that an accurate head count can be made. Supervisors will check off the names of all those reporting and will report those not checked off as missing to the Emergency Evacuation Coordinator.

4. The Emergency Evacuation Coordinator will be located at one of the following locations:

          A. Primary Location:

          B. Secondary Location:

5. The Emergency Evacuation Coordinator will determine the method to be utilized to locate missing personnel.

VIII. RESCUE AND MEDICAL DUTIES

It may become necessary in an emergency to rescue personnel and perform some specified medical duties, including first-aid treatment. All employees assigned to perform such duties will have been properly trained and equipped to carry out their assigned responsibilities properly and safely.

Assignments

Special

Name          Location              Assignment           Training Provided

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

Special Instructions and Procedures

All personnel performing emergency rescue and medical duties must follow these instructions:

1.

2.

3.

4.

5.

6.


Appendix A.

A summary of the evacuation rally points, together with the identities of supervisors and assigned employees who must report to each.

A sample escape procedure and escape route sheet of the type posted in work areas.


Appendix B

Describes operations, procedures, and personnel required in order for critical operations to be performed before the assigned personnel evacuate during emergency situations. A description of the special training provided is also included.


Appendix C

Specific rescue and medical duties have been assigned to designated individuals. These personnel have received special training and instructions for properly carrying out these assignments. A list of the individuals assigned and a summary of their training are attached for review.

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