Safety Checklist Program for Schools
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October 2003
DHHS (NIOSH) Publication Number 2004-101
Emergency Action Plan (Template)
DISCLAIMER:
Some of the additional resources listed below were provided by other organizations; they are intended to supplement the occupational safety and health information in this product. NIOSH is not responsible for the contents or accuracy of material obtained from these organizations. Furthermore, mention of any company or product does not constitute endorsement by NIOSH. In addition, citations to Web sites do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Also, NIOSH is not responsible for the content of these Web sites.
Emergency Personnel Names and Phone Numbers |
| DESIGNATED RESPONSIBLE OFFICIAL (Highest Ranking Manager at |
| _____________site, such as __________, ___________, or ____________): |
| Name:_______________________________________ Phone: (________________) |
| EMERGENCY COORDINATOR: |
| Name:_______________________________________ Phone: (______________) |
| AREA/FLOOR MONITORS (If applicable): |
| Area/Floor:__________________ Name:_______________________________
Phone: (_______________) |
| Area/Floor:__________________ Name:_______________________________
Phone: (_______________) |
| ASSISTANTS TO PHYSICALLY CHALLENGED (If applicable): |
| Name:______________________________________ Phone: (________________) |
| Name:______________________________________ Phone: (________________) |
| Date ____/____/____ |
- Page last reviewed: June 6, 2014
- Page last updated: June 6, 2014
- Content source:
- National Institute for Occupational Safety and Health Education and Information Division